Mental Health Physician Clinic

ldquoTraining on theIntegrated Behavioral Health

Services Regulationsrdquo

Resources

Resources

bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks

Resources

Resources

bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks

Resources

bullDHSSBH WebsitebullhttphealthhssstateakusdbhbullTraining Materials bullDocuments amp PublicationsbullFormsbullFAQrsquosbullRegulations bullLinks

Regulations Clarification Process1 Procedure for Providers to inquire about

meaning or applicability of BH Services Regulations

2 Mechanism for DHSSBH to explain (FAQ) or interpret (Clarification) BH Services Regulations

3 Method for compiling information leading to updates in Manual and potential revisions of BH Services Regulations

Regulations Clarification Cont

Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp

develops recommended response3 DHSSBH Executive Team reviews edits

and approves response 4 DHSSBH staff posts response as FAQ on

website and informs Provider OR5 Publishes response as Clarification in

Billing Manual and informs ALL Providers

MHPC Requirements

Definition 7AAC 160990(b)(95)

ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo

Qualified Professional Licensing Regulation

Licensed Psychologist 7AAC 110550

Licensed Psychological Associate AS 0886

Licensed Clinical Social Worker AS 0895

Licensed Physician Assistant 7AAC 110455

Licensed Advanced Nurse Practitioner

7AAC 110100

Licensed Psychiatric Nursing Clinical Specialist

AS 0868

Licensed Marital amp Family Therapist

AS 0863

Licensed Professional Counselor AS 0829

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Regulations Clarification Cont

Procedure1 Provider completes amp submits Form2 DHSSBH staff researches question amp

develops recommended response3 DHSSBH Executive Team reviews edits

and approves response 4 DHSSBH staff posts response as FAQ on

website and informs Provider OR5 Publishes response as Clarification in

Billing Manual and informs ALL Providers

MHPC Requirements

Definition 7AAC 160990(b)(95)

ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo

Qualified Professional Licensing Regulation

Licensed Psychologist 7AAC 110550

Licensed Psychological Associate AS 0886

Licensed Clinical Social Worker AS 0895

Licensed Physician Assistant 7AAC 110455

Licensed Advanced Nurse Practitioner

7AAC 110100

Licensed Psychiatric Nursing Clinical Specialist

AS 0868

Licensed Marital amp Family Therapist

AS 0863

Licensed Professional Counselor AS 0829

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

MHPC Requirements

Definition 7AAC 160990(b)(95)

ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo

Qualified Professional Licensing Regulation

Licensed Psychologist 7AAC 110550

Licensed Psychological Associate AS 0886

Licensed Clinical Social Worker AS 0895

Licensed Physician Assistant 7AAC 110455

Licensed Advanced Nurse Practitioner

7AAC 110100

Licensed Psychiatric Nursing Clinical Specialist

AS 0868

Licensed Marital amp Family Therapist

AS 0863

Licensed Professional Counselor AS 0829

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Definition 7AAC 160990(b)(95)

ldquoMental health physician clinic means a clinic operated by one or more psychiatrists that exclusively or primarily provides mental health clinic services furnished by a psychiatrist or by one or more qualified professionalsrdquo

Qualified Professional Licensing Regulation

Licensed Psychologist 7AAC 110550

Licensed Psychological Associate AS 0886

Licensed Clinical Social Worker AS 0895

Licensed Physician Assistant 7AAC 110455

Licensed Advanced Nurse Practitioner

7AAC 110100

Licensed Psychiatric Nursing Clinical Specialist

AS 0868

Licensed Marital amp Family Therapist

AS 0863

Licensed Professional Counselor AS 0829

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Qualified Professional Licensing Regulation

Licensed Psychologist 7AAC 110550

Licensed Psychological Associate AS 0886

Licensed Clinical Social Worker AS 0895

Licensed Physician Assistant 7AAC 110455

Licensed Advanced Nurse Practitioner

7AAC 110100

Licensed Psychiatric Nursing Clinical Specialist

AS 0868

Licensed Marital amp Family Therapist

AS 0863

Licensed Professional Counselor AS 0829

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

MHPC Requirements 7 AAC 135030

1 Must be enrolled in Medicaid under 7 AAC 105210 2 Services are for treatment of a diagnosable mental health

disorder3 Services provided by psychiatrist or licensed professionals4 Psychiatrist operating MHPC provides direct supervision to

staff and assumes responsibility for the treatment given5 Necessary adjunctive treatment provided directly or through

written agreement with a MHPC or other member of the MHPC staff

6 Services provided on MHPC premises or via telemedicine under 7 AAC 110620 - 7 AAC 110639 unless the service

a could not otherwise be provided orb is provided at a location clinically more appropriate than

MHPC c reason that service was provided in alternate location or

via telemedicine is clearly documented in recipients clinical record

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

MHPC Requirements 7 AAC 135030

1 Psychiatrist operating MHPC must provide direct supervision to each qualified staff

2 Direct supervision meansA Psychiatrist on premises to deliver medical services

at least 30 of operating hours B Approve all treatment plans in writingC Review each case every 90 - 135 days to determine

the need for continued careD Provide direct clinical consultation and supervisionE Assure services provided are medically necessary

and clinically appropriateF Assume professional responsibility for services

provided

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

MHPC Services

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Clinic Service Limits amp Requirements

A MHPC may provide the following behavioral health clinic services without prior authorization from the department per recipient per State fiscal year

1 Psychotherapy 10 hours (any combination of individual group and family) 2 Psychiatric assessments 4 assessments3 Psychological testing and evaluation 6 hours4 Neuropsychological testing and evaluation 12 hours (must document

providers qualifications to provide neuropsychological testing and evaluation services)

5 Pharmacologic management services 1 visit per week (first four weeks) 1 visit per month thereafter unless more frequent monitoring is required because

a the requirements of the specific medication orb a recipients unusual clinical reaction to a medication

6 Assessment 1 Integrated mental health and substance use intake assessment OR 1 Mental health intake assessment every six months

7 Short-term crisis intervention services 22 hours8 Screening and brief intervention services (SBIRT) 1 billable service per

day

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Payment

If a physician provides clinic services in a MHPC the physician may submit a claim for payment

A using the MHPC medical assistance provider identification number (payment subject to requirements and restrictions placed on MHPC) OR

B using the physicians medical assistance provider identification number (payment subject to requirements and restrictions placed on a physician)

NOTE Services must be medically necessary and clinically appropriate and must be rendered directly by the physician

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Mental Health Intake Assessment

A Mental Health Intake Assessment must be1 Conducted by a mental health professional clinician2 Conducted upon admission to services amp updated as new information becomes available3Conducted for the purpose of determining

a recipientrsquos mental status social and medical historiesb nature amp severity of any mental health disorderc complete multi-axial DSM diagnosisd functional impairmentse treatment recommendations to form Tx Plan

See 7 AAC 135130 for more information on documentation

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Integrated Mental Health and Substance Use Intake Assessment

1 Documented in accordance with 7 AAC 135130 (Clinical Record)

2 Conducted by a mental health professional cliniciana Upon admission to services amp during the course of

active treatment as necessaryb Updated as new information becomes available

3 Conducted for the purpose of determining1 All the requirements of a Mental Health Intake

Assessment2 If the recipient has a substance use disorder3 Nature amp severity of any substance use disorder

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Psychiatric Assessments

ldquoThe Dept will pay a MHPC for a psychiatric assessment that may serve as the Professional Behavioral Health Intake Assessment if the recipients condition indicates the need for a more intensive assessment including an assessment to evaluate the need for medicationrdquo

A psychiatric assessment must be conducted by a licensed practitioner who is Physician Physician Asst Advanced Nurse Practitioner working within the scope of their education training and

experience has prescriptive authority enrolled under 7 AAC 120100(c) as a dispensing provider

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Psychiatric Assessments Cont

Both types of Psychiatric Assessments must include

bull a review of medical amp psychiatric history or presenting problem

bull a relevant recipient historybull a mental status examinationbull a complete multi-axial DSM diagnosis bull a listing of any identified psychiatric problems

including functional impairmentsbull treatment recommendations

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Psychological Testing and Evaluation

ldquoThe Dept will pay a MHPC or psychologist for psychological testing and evaluation to assist in the diagnosis and treatment of mental and emotional disordersrdquo

Psychological testing and evaluation includes

bull the assessment of functional capabilities

bull the administration of standardized psychological tests

bull the interpretation of findings

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Pharmacologic ManagementldquoThe Dept will pay a MHPC for a pharmacologic management

service if that service is provided directly by a professional described in 7 AAC 135010(b)(2)rdquo

To qualify for payment a provider must monitor a recipient for the purposes of

1 assessing a recipients need for pharmacotherapy2 prescribing appropriate medications to meet the

recipients need and3 monitoring the recipients response to medication

includinga documenting medication complianceb assessing amp documenting side effects c evaluating amp documenting effectiveness ofthe medication

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Psychotherapy

ldquoThe department will pay a MHPC for one or more

of the following forms of psychotherapy as codedin Current Procedural Terminology (CPT)rdquo

insight-oriented individual psychotherapyinteractive individual psychotherapygroup psychotherapyfamily psychotherapy - without recipientfamily psychotherapy - with recipientmulti-family group psychotherapy

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Psychotherapy ClarificationBiofeedback or relaxation therapy may be

provided as an element of insight-oriented and interactive individual psychotherapy if

1 prescribed by a psychiatrist (if provided in MHPC)

2 included in the behavioral health treatment plan as a recognized treatment or adjunct to a treatment only for the following conditions or substantially similar conditions

a chronic pain syndromeb panic disordersc phobias

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Short-Term Crisis InterventionldquoThe Dept will pay a MHPC for short-term crisis

intervention services provided by a mental health professional clinician to a recipient if that mental health professional clinician provides an initial assessment of

1) the nature of the short-term crisis 2) recipients mental emotional and behavioral status 3) recipients overall functioning in relation to the

short-term crisisrdquo

A MHPC is NOT required to use Dept form to document short-term crisis intervention

A MHPC may bill the same number of hours for service as a CBHS Provider22hrs per SFY

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Facilitation of TelemedicineldquoThe department will pay a MHPC for facilitation of a

telemedicine session if the facilitating provider1 provides the telemedicine communication equipment2 establishes the electronic connection used by treating provider and recipient 3 remains available during session to reestablish the electronic connection if it fails before the intended end of the telemedicine sessionrdquo

The facilitating provider must make a note in the recipients clinical record summarizing the facilitation of each telemedicine session

The facilitating provider is not required to document a clinical problem or treatment goal in the note

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Screening amp Brief Intervention

ldquoThe Dept will pay a MHPC for screening and brief intervention services if staff conducts the screening component and brief intervention utilizing self-report questionnaires structured interviews (or similar screening techniques) to detect substance use problems and to identify the appropriate level of interventionrdquo

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Screening amp Brief Intervention (conrsquot)

Brief intervention is motivational discussion focused on

raising awareness of recipientrsquos substance usethe potential harmful effects of substance useencouraging positive changeBrief intervention may include1 Feedback2 Goal setting 3 Coping strategies4 Identification of risk factors5 Information amp advice

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Screening amp Brief Intervention (conrsquot)

MHPC must refer to appropriate program that will meet recipientrsquos needs if

1 Screening reveals severe risk of substance use

2 Recipient is already substance use dependent

3 Recipient already received SBIRT and was unresponsive

MHPC must document SBIRT in progress note

SBIRT does not require assessment or Tx Plan

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Documentation Requirements

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Clinical Record RequirementsThe clinical record must include

bullAn assessmentbullA behavioral health treatment plan that

meets the requirements of 7AAC 135120bullA progress note for each day the service is

provided signed by the individual providerbullMust reflect all changes made to the

recipientrsquos treatment plan amp assessmentbullMust set out a description or listing of the

active interventions that the provider provides to or on behalf of the recipient in order to document active treatment

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Treatment Plan

bull Documented in accordance with 7 AAC 135130 (clinical record)

bull Based on a behavioral health assessmentbull Developed with the recipient or recipientrsquos legal

representative (18 and older)bull Based upon the input of a Treatment Team if the

recipient is a child (under 18)bull Signed and supervised by psychiatrist operating

MHPC and by the recipient or the recipientrsquos parent or legal representative

bull Reviewed every 90-135 days to determine need for continued care

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Treatment Plan Documentation

bullRecipientrsquos identifying informationbullThe date implementation of plan will beginbullTreatment goals that are directly related

to the findings of the assessmentbullThe services and interventions that will be

rendered to address the goalsbullThe name signature and credentials of

the psychiatrist operating MHPCbullThe signature of the recipient or the

recipientrsquos parent or legal representative

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Treatment TeamAs it applies to a MHPC a behavioral health treatment team for a

recipient under 18 must include

bull The recipientbull The recipientrsquos family members including parents guardians

and others involved in providing general oversight to the clientbull A staff member from OCS if the recipient is in statersquos custody bull A staff member from DJJ if the recipient is in their custodybull [Licensed] clinic staff

A behavioral health treatment team for a recipient under 18 may include

bull Representative(s) from alternative living arrangements including foster care residential child care or an institution

bull Representative(s) from the recipients educational system

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Treatment Team Cont

All members of treatment team shall attend meetings of the team in

person or by telephone and be involved in team decisions unless the clinical record documents that

1 the other team members determine that participation by the recipient or other individual involved with the care of the recipient is detrimental to the recipients well-being

2 family members school district employees or government agency employees refuse to or are unable to participate after the providers responsible efforts to encourage participation or

3 weather illness or other circumstances beyond the members control prohibits that member from participating

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Progress Notes

7AAC 135130(8) Requires

bull Documented progress note for each service each day service is provided

bull Date service was providedbull Duration of the service expressed in service units

or clock time bull Description of the active treatment provided

(interventions)bull Treatment goals that the service targetedbull Description of the recipientrsquos progress toward

treatment goalsbull Name signature and credentials of the individual

who rendered the service

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Medicaid Billing

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Medicaid is Payer of Last Resort

bull If the recipient is covered eligible for benefits by other public or private health plan that plan must be billed before billing MedicaidMedicare recipients with ldquoDual Eligibilityrdquo

under both programs (ie disabled adults and adults over age 65) may be eligible under both Medicare and Medicaid

Military and Veteranrsquos Benefits Private Health Insurance

bullThe recipientrsquos cardcoupon will include Resource Code andor Carrier Code to designate this coverage

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Behavioral Health Medicaid Payment

bull Before Medicaid can pay for Behavioral Health Services the individual must be eligible for Medicaid

bull There are various paths to Medicaid eligibility and the Division of Public Assistance is responsible for determining eligibility for all categories except children in State Custody

bull The provider should request to see proof of eligibility at the time of service by viewing the recipientrsquos coupon or card issued by Division of Public Assistance (Medicaid coupon Denali KidCare Card)

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

CAMA

bullCAMA is the acronym for Chronic and Acute Medical Assistance

bullCAMA IS NOT Medicaid CAMA is100 state fund Medical Assistance for a

limited number of health conditions andHas very limited coverage

bullMHPC are not covered by CAMAbullCAMA coverage also includes limits the

number of medications a person can receive in a month

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Medicaid Program Policies amp Claims Billing Procedures Manual

Section I ndash Program Policies and Claims Billing Procedures for MHPC Services PART A ndash General RequirementsPART B ndash Service Detail Sheets

Section I Appendicesbull Appendix I-A ndash Medical Assistance Provider Enrollment and Provider Agreementbull Appendix I-B ndash Medical Assistance Recipient Eligibilitybull Appendix I-C ndash Clinical Documentation Requirementsbull Appendix I-D ndash Billing and Payment Informationbull Appendix I-E ndash Regulations Clarification of Integrated BH Services Regulations

Section II ndash Attachments and Remittancesbull Attachmentsbull Supplemental documentsbull Remittance Advice (RA) Reconciliationbull AdjustmentsVoidsbull Claim Inquirybull Forms Order

Section III ndash General Medical Assistance Information bull Claims Processing Overviewbull Eligible Recipients for ALL programsbull General Program Regulations and Restrictions

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Services

New Codes Services Changing Services Codes

Code Service Description

H0031-HH

Integrated Mental Health amp Substance Use Intake Assessment

Q3014 Facilitation of Telemedicine

90846 Psychotherapy Family w out patient present

S9484-U6

Short-Term Crisis Intervention (15 min)

99408 Screening Brief Intervention amp Referral for Treatment

Code Description Change

H0031 Mental Health Assessment

bullUnits were based on time with 3 hr maxbullNow based on 1 assessment payable at flat rate

90849 Psychotherapy Multi Family Group

bullChange in RatebullRate was $ 5600 per hourbullRate is now $11000 per hour

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Service Authorization bullAnnual Service Limits will switch from

CALENDAR year to STATE FISCAL yearAll Existing Prior Authorization records

currently in Medicaid Management Information System (MMIS) will be updated with an END DATE of 11302011 to facilitate this change

bullRequests to be made in correlation with requirement to review each case to determine need for continued treatmentRequests will cover a maximum of 90 to 135

days of planned services and will be submitted approximately 3 to 4 times annually

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

How to find Alaska Medicaid Information using Affiliated Computer Services Inc (ACS) Website

bull start at the fiscal agentrsquos Alaska Medical Assistance page (httpwwwmedicaidalaskacom)bull select ldquoProviders located in the horizontal list at the top of the page bull select ldquoBilling Manuals click on the boxed word ldquoAcceptrdquo at the bottom of the page to indicate your

agreement and acceptance of the copyright notice Claim form instructions

CMS-1500 Professional Services (Set B is for use by outpatient behavioral health services providers) UB-04 Institutional Services (inpatient and residential psychiatric treatment center services

Program Policies amp Claims Billing Procedures Manuals for all covered services are listed alphabetically Mental Health Physician Clinic Other Service Providers (Physician Advanced Nurse Practitioner Federally Qualified Health Center

School Based Services)bull select ldquoForms

Provider Enrollment Application forms Information Submission Agreements Service Authorization Forms

bull select ldquoUpdatesrdquo Manual replacement pages

bull select ldquoHIPAA Companion Guides for all Electronic Transactions Tool kit testing procedures and other information for becoming an electronic submitterreceiver

bull select ldquoTraining to view the training schedule register for a class or view past materialsbull select ldquoContact Usrdquo for designated work units staff mailing addresses etc

Fiscal Agent Functionsbull Processes all Medical Assistance claims including technical

support to accommodate electronic submission of claims and other transactions

bull Provides customer service for providers and recipientsbull Enrolls providers in Medical Assistancebull Provides Medical Assistance billing training to the provider

communitybull Publishes and distributes program policy amp billing manualsbull Maintains website of information for providersbull Authorizes some servicesbull Performs First Level Provider Appealsbull Performs Intake for Recipient Fair Hearing Requestsbull Generates and issues claim payments and tax informationbull Performs Surveillance and Utilization Review (program

integrity)

Claims Billing and Payment Tools amp Support

bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra

Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800

bull Websitesbull ndash Fiscal Agent (ACS)

wwwmedicaidalaskacombull ndash DHSSDBH

wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims

Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12

MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT

bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier

Claims EditingAll edits are three-digit codes with explanations of how

theclaim was processed

ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service

ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)

The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within

thatspecific Remittance Advice

- Contact ACS Inc Provider Inquiry for clarification as needed

Integrated BH Regulations TrainingClaims Adjudication Process

Flow

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Claims Billing and Payment Tools amp Support

bull Program Policy amp Billing Manualsbull Provider Trainingbull Provider Inquiry Enhanced Provider Support Chandra

Lewis in-state toll free (800) 770-5650 or Anchorage (907) 644-6800

bull Websitesbull ndash Fiscal Agent (ACS)

wwwmedicaidalaskacombull ndash DHSSDBH

wwwhssstateakusdbhbull ndash DHSSDHCS wwwhssstateakusdhcsbull Technical Support for Electronic Claims

Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12

MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT

bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier

Claims EditingAll edits are three-digit codes with explanations of how

theclaim was processed

ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service

ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)

The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within

thatspecific Remittance Advice

- Contact ACS Inc Provider Inquiry for clarification as needed

Integrated BH Regulations TrainingClaims Adjudication Process

Flow

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Claims Filing Limitsbull ALL CLAIMS MUST BE FILED WITHIN 12

MONTHS OF THE DATE SERVICES WERE PROVIDED TO THE PATIENT

bull The 12-month timely filing limit applies to all claims including those that must first be filed with a third party carrier

Claims EditingAll edits are three-digit codes with explanations of how

theclaim was processed

ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service

ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)

The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within

thatspecific Remittance Advice

- Contact ACS Inc Provider Inquiry for clarification as needed

Integrated BH Regulations TrainingClaims Adjudication Process

Flow

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Claims EditingAll edits are three-digit codes with explanations of how

theclaim was processed

ndash Adjudicated Claims (Paid or Denied)bull reduction in paymentbull denial of service

ndash In-process claims (further internal review or information needed)bull pending status requiring internal staff reviewbull additional information requested from the provider (via RTD)

The Remittance Advice (RA) statement includes anExplanation of Benefit (EOB) description page that lists allEOB codes and a brief description of each found within

thatspecific Remittance Advice

- Contact ACS Inc Provider Inquiry for clarification as needed

Integrated BH Regulations TrainingClaims Adjudication Process

Flow

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Integrated BH Regulations TrainingClaims Adjudication Process

Flow

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Provider Appeals

REASONS to Request an AppealDenied or reduced claims (180 days)Denied or reduced prior authorization (180

days)Disputed recovery of overpayment (60

days)Three Levels of Appeals

First level appeals Second level appealsCommissioner level appeals

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

Recommend Billing Processesbull Read and maintain your

billing manualbull Verify recipient eligibilitybull Verify eligibility codebull Verify dates of eligibilitybull Verify Third Party Liabilitybull Verify the services you are

eligible to providebull Verify procedure codesbull Obtain Service

Authorization if applicable bull File your license renewals

andor certificationpermits timely (keep your enrollment current)

bull Ensure completion of claim forms (reference provider manual)bull Document Third Party Liability payment on claim if applicable bull Include attachments as requiredbull FILE TIMELYbull RECONCILE PAYMENTSbull Read and distribute RA messagesbull Address problemsissues promptlybull Call Provider Inquiry with questions

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49

THANK YOU FOR ATTENDING

• Mental Health Physician Clinic
• Resources
• Resources (2)
• Regulations Clarification Process
• Regulations Clarification Cont
• MHPC Requirements
• Definition 7AAC 160990(b)(95)
• Slide 8
• MHPC Requirements 7 AAC 135030
• MHPC Requirements 7 AAC 135030
• MHPC Services
• Clinic Service Limits amp Requirements
• Payment
• Mental Health Intake Assessment
• Integrated Mental Health and Substance Use Intake Assessment
• Psychiatric Assessments
• Psychiatric Assessments Cont
• Psychological Testing and Evaluation
• Pharmacologic Management
• Psychotherapy
• Psychotherapy Clarification
• Short-Term Crisis Intervention
• Facilitation of Telemedicine
• Screening amp Brief Intervention
• Screening amp Brief Intervention (conrsquot)
• Screening amp Brief Intervention (conrsquot) (2)
• Documentation Requirements
• Clinical Record Requirements The clinical record must include
• Treatment Plan
• Treatment Plan Documentation
• Treatment Team
• Treatment Team Cont
• Progress Notes
• Medicaid Billing
• Medicaid is Payer of Last Resort
• Behavioral Health Medicaid Payment
• CAMA
• Medicaid Program Policies amp Claims Billing Procedures Manual
• Services
• Service Authorization
• How to find Alaska Medicaid Information using Affiliated Com
• Fiscal Agent Functions
• Claims Billing and Payment Tools amp Support
• Claims Filing Limits
• Claims Editing
• Slide 46
• Provider Appeals
• Recommend Billing Processes
• Slide 49