APS HEALTHCARE
 
 
 

Licensed Behavioral Health Centers - FAQ
2014 Clinic and Rehabilitation Manuals

 

Billing separately for scoring and interpretation of the 96101

Recouping costs of self-administered or computer administered tests

Start and stop times for face to face testing and report writing

Claiming time for writing 96101 reports

15 day timeline when testing must be done over several days

H0031 code for cases of suspected abuse or neglect - examples

Purpose of the global H0031 assessment

H0031 Mental Health Assessment for children aging out of Birth to Three services

Medically necessary diagnosis for focused services

Guidelines for defining medical necessity for H0004

Attaching the 72 hour authorization form to the Clinic and Rehabilitation manual

Rendering diagnosis for a focused therapy client

DSM 5 diagnosis and date recognized

Necessary diagnosis for the movement of members to/from coordinated care to focused care

Billing for an initial service plan when the member is entering Focused Care

DSM-IV and DSM 5 diagnosis requiring the presence of a physician or psychologist

Focused Care treatment strategy as a stand-alone document

Examples of a treatmment strategy

Coordinated care under the Rehabilitation manual - required service plan attendees

Service planning - required members of a disciplinary team

Counting the required seven days for the initial plan

Criminal background checks or OIG checks and hiring staff

Timeframe for provider to file their claims for reimbursement

Master’s level therapist and providing therapy without a license

Billing for services provided over the phone

Matching a provider's plan of correction to OFLAC’s

Fingerprinting long-term employees

Declining Birth to Three services and choosing a different behavioral health care

H2011 (Crisis Intervention) - dating the beginning and end of a crisis

ACT team members and meeting on weekends and holidays

ACT members if an ACT team is decertified for any reason

Master’s level clinician providing services to non-ACT members

Applying if you already have a CFT program

Behavior management implementation for residential services to meet daily requirements

Recommendation in the H0031 as a treatment strategy for focused services

Coordinated care and service planning - examples of representatives from various services

Intake - focused or coordinated care

Minimum degree requirements for supportive counselors

Current supportive counselors and the B.A. degree requirement

Exceeding the minimum therapy requirements during the phases of NMMAT

LPN requirement for providing crisis stabilization services

Provider buildings and ACT communtiy requirements

Focused services and supportive counseling as coordinated services

Group limits for Professional or Supportive Counseling

National background checks and the three year requirement

Requirements for reviewing, signing, and approving all Service Plans within 72 hours

Required additional H0031 (Mental Health Assessment by Non-Physician)

Redoing the Global Assessment

Gold Card and the requirement of a Board Approved Supervised Psychologist

Medication management and pre-authorization

Comprehensive Community Support Services rosters

Psychotropic medication and outside physicans or agencies

Agency contracted physicians prescribing psychotropic medication through private practice

Service plan reviews and team requirements

Eligible diagnosis for Clinic vs. Rehabilitation services

ACT service and medication delivery policy

ACT required contact per member per week

Initial service plan - required attendees

Medication management services as residential bundle or separately billed

Signing the Coordination of Care and Release of Information Form for NMMAT

Supervising the registered nurse used for the H0031

Billing the H0031 and 90791 on the same day

HB4208, the Non-Methadone Policy and the WV Clinic and Rehabilitation Manuals

 

1. Is the psychologist permitted to bill the time spent on scoring and interpretation of the 96101 separately?

No. The psychologist is allowed to count their time spent (manually or hand) scoring and interpreting tests. Time required for the computer or any other staff member to score and/or interpret tests is not allowed.
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2. Can costs of self-administered or computer administered tests be recouped?

These costs have already been included in the Medicaid rate.  The reimbursement per unit of this procedure code (96101) is a RBRVS rate or a Resource Based Relative Value Scale rate.  The Center for Medicare and Medicaid Services began utilizing this reimbursement methodology in 1992 and the rates are regularly adjusted.  This methodology incorporates three primary components and factors in the geographical region to determine the reimbursement rate.  These components are:

  • physician’s work, or in this case psychologists’ work,  based on the definition of the Current Procedural Terminology (CPT) code definition maintained by the American Medical Association.
  • practice expense which includes the material supplies such as the workbooks, non-physician labor, pro rata equipment costs and indirect costs  
  • professional liability insurance or “malpractice insurance”

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3. If a psychologist does testing face to face and writes the report at a later date, are start and stop times required for both?

Yes. Since the service is not completed until the documentation is finished, the start and stop times of each component must be documented when they are conducted at different times or dates.
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4. Can you claim time for writing the reports for the 96101?

Report writing is required documentation for the 96101 but is not an active service of the 96101. Time spent documenting a service is not reimbursable for any WV Medicaid service.
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5. If you have a member who must be tested over several days, does the 15 day timeline start from the last test that was completed?

No. The 15 day timeline starts from the first date of service.
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6. The H0031 states: “This code may also be used for special requests of WV DHHR for assessment reports and court testimony on adults or children for cases of suspected abuse or neglect.” What would be some examples of this?

This may occur if a provider is asked to assess if the behaviors and/or symptoms the member is displaying may be related to a behavioral health and/or an intellectual developmental disability, experiencing abuse/neglect or a combination of both and what if any behavioral health services would be appropriate. H0031 does not cover the actual time spent testifying in court. Testimony time may be reimbursed by the Bureau for Children and Families if the provider is called as an expert witness.
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7. What is the purpose of the global H0031 assessment?

The global H0031 assessment is a tool by which a clinician can assess the ongoing needs of the member and reaffirm that the treatment provided is medically necessary.
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8. The manual indicates the H0031 Mental Health Assessment by Non-Physician should not be used for members under the age of 3. If a child is close to turning 3 years of age and referred to an agency by Birth to Three, is it okay to do a H0031 before beginning behavioral health services?

Yes, if a child is aging out of Birth to Three services, an assessment can be done which will allow a smooth transition into other needed services.
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9. The manual states (Medical Necessity section) that a medically necessary diagnosis must be rendered by a physician or psychologist. Is this true of focused services as well?

Yes. A physician or psychologist must approve the diagnosis and services rendered to any Medicaid member. It is up to the provider how they would prefer to document this. Examples would include a co-signature on the H0031 or treatment strategy that includes the diagnosis, or a 72 hour authorization form.
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10. Are there specific guidelines for defining medical necessity for H0004 (Supportive Counseling)?

The guidelines for every service are the same as listed under the Medical Necessity section of the manual. Each service must also meet the service definition.
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11. Can the 72 hour authorization form be attached to the Clinic and Rehabilitation manual and not put it in a separate place?

Yes.
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12. Does a diagnosis for a focused therapy client have to be rendered by a physician or psychologist? Can a clinical social worker or licensed professional counselor render a diagnosis as part of their scope of practice?

While the respective boards for social workers and counselors may deem rendering a diagnosis with in their scope of practice, only a physician or psychologist may do so for those receiving Medicaid behavioral health services in the Clinic and Rehabilitation manuals.
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13. When will WV Medicaid and APS Healthcare recognize DSM 5 diagnosis?

Since there are issues between the DSM-5 and the ICD-10, WV Medicaid will remain with DSM IV-TR and ICD-9. However, anyone wishing to adopt the DSM 5/ICD 10 diagnostic style for their report writing may do so. It should be documented which version you are using in your reports. Any updates on this will be communicated to providers in advance.
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14. What type of documentation is necessary for the movement of members from coordinated care to focused care and vice-versa?

The provider needs to document in the case file when a member changes to and from focused to coordinated care. The documentation should include the clinical reasons for the change.
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15. Can you bill for an initial service plan when the member is entering Focused Care?

No, members in focused care are ineligible for Service Planning.
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16. May we have a list of DSM-IV and DSM 5 diagnosis that would require the presence of a physician or psychologist at the service planning meeting?

Yes, please see below.  This list is not all inclusive and does not negate the provider’s decision to include physicians or psychologists in a meeting if clinically warranted.

DSM IV and DSM 5 Diagnosis that require the presence of a physician or psychologist at Coordinated Care Service Plan meetings.

DSM IV

 

DSM 5

317.00

Mild Mental Retardation/Intellectual Disability

 

319.00

Intellectual Disability

318.00

Moderate Mental Retardation/Intellectual Disability

 

315.80

Global Developmental Delay

318.10

Severe Mental Retardation/Intellectual Disability

 

 

 

318.20

Profound Mental Retardation/Intellectual Disability

 

 

 

319.00

Unspecified Mental Retardation/Intellectual Disability

 

319.00

Unspecified Intellectual Disability

299.00

Autistic Disorder

 

299.00

Autism Spectrum Disorder

299.80

Rett’s Disorder

 

 

 

299.10

Childhood Disintegrative Disorder

 

 

 

299.80

Asperger’s Disorder

 

 

 

299.80

Pervasive Developmental Disorder NOS

 

315.80
315.90

Other or Unspecified Neurodevelopmental Disorder

313.89

Reactive Attachment of Infancy or Early Childhood

 

313.89
313.89

Reactive Attachment Disorder
Disinhibited Social Engagement

295.**

Schizophrenia

 

295.90

Schizophrenia

295.40

Schizophreniform Disorder

 

295.40

Schizophreniform Disorder

295.70

Schizoaffective Disorder

 

295.70
295.70

Schizoaffective Disorder – Bipolar Type
Schizoaffective Disorder – Depressive Type

297.10

Delusional Disorder

 

297.10

Delusional Disorder

298.80

Brief Psychotic Disorder

 

298.80

Brief Psychotic Disorder

297.30

Shared Psychotic Disorder

 

 

 

293.81
293.82

Psychotic Disorder due to a Medical Condition

 

293.81

293.82

Psychotic Disorder due to Another Medical Condition – with Delusions

  • With Hallucinations

 

 

 

293.89

Catatonia
-Associate with Another Mental Disorder
-Due to Another Medical Condition
-Unspecified

See Substance Related Codes

Substance Induced Psychotic Disorder

 

See ICD codes

Substance/Medication Induced Psychotic Disorder

298.90

Psychotic Disorder NOS

 

298.80

298.90

Other Specified Schizophrenia Spectrum and Other Psychotic
Unspecified Schizophrenia Spectrum and Other Psychotic

 

 

 

296.99

Disruptive Mood Dysregulation

296.**

Major Depressive Disorder

 

296.**

Major Depressive – with specifiers

296.**

Bipolar I Disorder

 

296.**

Bipolar Disorder I – with specifiers

296.89

Bipolar II Disorder

 

296.89

Bipolar Disorder II

296.80

Bipolar Disorder NOS

 

296.89
296.80

Other Specified Bipolar and Related
Unspecified Bipolar and Related

300.30

Obsessive Compulsive Disorder

 

300.30

Obsessive Compulsive

309.81

Post-Traumatic Stress Disorder

 

309.81

Post-Traumatic Stress

308.30

Acute Stress Disorder

 

308.30

Acute Stress

303.90

Alcohol Dependence

 

303.90

Alcohol Use – Moderate or Severe

304.40

Amphetamine Dependence

 

304.40

Amphetamine Type Substance Use – Moderate or Severe

305.60

Cocaine Dependence

 

304.20

Cocaine Use – Moderate or Severe

304.50

Hallucinogen Dependence

 

304.50

Other Hallucinogen Use – Moderate or Severe

305.90

Inhalant Abuse

 

305.90

Inhalant Use - Mild

304.60

Inhalant Dependence

 

304.60

Inhalant Use – Moderate or Severe

304.00

Opioid Dependence

 

304.00

Opioid Use – Moderate or Severe

304.90

Phencyclidine Dependence

 

304.60

Phencyclidine Use – Moderate or Severe

304.10

Sedative-Hypnotic-or Anxiolytic Dependence

 

304.10

Sedative-Hypnotic-or Anxiolytic Use – Moderate or Severe

304.80

Polysubstance Dependence

 

 

 

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17. Does the Focused Care treatment strategy need to be a stand-alone document?

No. The treatment strategy may be a stand-alone document but may also be found in the recommendation section of the assessment or in the progress notes.
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18. Where can I review examples of a treatment strategy?

Individualized training is available if you have questions regarding this policy. For training, please contact your assigned Trainer/Consultant or contact the office of the contracted ASO.
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19. In coordinated care under the Rehabilitation manual, are the physician/extender and psychologist/supervised psychologist interchangeable for approval or attendance at the service planning meeting?

Yes. The physician/extender and psychologist/supervised psychologist can approve and/or attend service plans. The agency may have more stringent requirements than WV Medicaid, if they wish, for when they prefer a physician or psychologist to provide oversight to services based on the needs of the member. In the Clinic manual, a physician/extender is required for approval and attendance at service plan meetings.
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20. Regarding service planning, what constitutes an “entire disciplinary team”? What members are required?

The service planning meeting requires the attendance of the member, the member’s legal representative if applicable, and the staff members (or representative thereof) who are providing services to the member.  Behavioral health providers outside of the agency that are also serving the member must be invited to the meeting as well as other interested parties such as CPS or Youth Service workers. 

The psychologist or physician may be required to be in attendance or may simply need to review and approve the service plan. If the clinician providing direct service is unavailable for the meeting, the representative of this clinician must be of equal or greater credential.  One clinician is allowed to represent more than one service provider (i.e. One clinician represents the case manager and the supportive counselor at the meeting, or, one clinician represents the therapist and behavior management specialist).
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21. How are the required seven days for the initial plan counted? Do both the first day and plan day count (Monday through Sunday for 7 days or Monday to Monday)?

The first day counts toward the total 7. The initial plan is required within 7 days of the beginning date of service. If services begin on Monday, the plan is required to be in the chart by Sunday.
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22. Do the criminal background checks or OIG checks have to be completed before hiring staff?

No, although they do have to be completed before that staff is eligible to perform any WV Medicaid service.
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23. How long does the provider have to file their claims for reimbursement?

The providers have 12 months to file their claims from the date of service. If there is an issue with a claim that is filed, the provider then has 12 months from that date to resolve the issue.
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24. Is it permissible for a Master’s level therapist to provide therapy without a license?

Yes, although only in the Clinic and Rehabilitation manuals. Please refer to the staff requirements for therapeutic services.
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25. Can you ever bill for services in either the Clinic or Rehabilitation manuals provided over the phone?

No, this is not permitted.
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26. If a plan of correction is required by the provider, will it be formatted to match OFLAC’s?

The plan of correction will be developed by a joint effort from BMS, providers, and others with the goal of making it as quick and simple as possible.
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27. If staff person has been employed with the provider for numerous years, do they have to have fingerprints after July 1, 2014?

Not at the current time. Only new staff hires will need to be fingerprinted. The State is currently working to establish a criminal background check system and all employees will be required to be fingerprinted when it is implemented. Further questions may be referred to Meghan Sheares, Criminal Background Check Director at BMS 304-558-1700.
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28. Can families decline Birth to Three services and choose a different behavioral health care?

a. Families have the right to decline Birth to Three Services. However, CMS does not recommend Behavioral Health treatment for children under the age of 4. Pediatricians, Birth to Three and Headstart offer a greater variety and more appropriate services for this age group.

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29. On the H2011 (Crisis Intervention), what constitutes the beginning/end of a crisis? We were previously told to only use the H2011 to stabilize and then the service shifts to a H0004H0 session.

Crisis intervention is an unscheduled intervention with a member who is in crisis related to acute or severe psychiatric signs or symptoms. The intervention should be immediate and include an assessment of the situation, immediate stabilization of the situation, and creation of a brief plan. Once the plan is created, the service should end. It may be appropriate for crisis intervention to lead to another treatment service such as professional counseling or TCM if that service is deemed to be medically necessary.
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30. Must every ACT team member meet every day including weekends and holidays?

The ACT Team must meet daily to review all cases in their caseload. Weekend and Holiday Team Meetings may be on a rotating basis. Staff must be sufficient to meet ACT member needs including but not limited to: medication delivery, crisis response via phone or face to face, and therapeutic services to promote stability. The ACT staff person on call must review every member with the ACT team leader or the team leader’s designee each weekend day and holiday. The physician must be accessible for medication adjustments etc.
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31. If an ACT team is decertified for any reason, what should be done with all of the ACT members?

If an ACT team is decertified by BMS, all the ACT members will need to be referred to other programs and/or providers within 60 days.
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32. If a provider has more than the 5 core team members on an ACT team, can the additional Master’s level clinician provide services to non-ACT members?

Yes.
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33. If we have a CFT program already, do we have to reapply?

No, only new CFT programs must apply.
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34. To meet the daily treatment requirements for residential services, can behavior management implementation be used instead of supportive counseling?

Residential services have a group of services they can provide. Also, separate authorizations are sometimes available for services outside of the bundle. The residential facility is required to offer a whole array of services to be provided to each child based upon their assessed need and medical necessity. Behavior management implementation and supportive counseling are optional services to choose from.
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35. Does the recommendation in the H0031 count as a treatment strategy for a client receiving focused services?

If the clinician completing the H0031 is also going to be providing the focused services, the treatment strategy can be documented on the H0031.
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36. Regarding coordinated care and service planning, could you give examples of representatives from the various services?

During service planning, there needs to be someone representing each service the client is to receive. So you might have the therapist, case manager, CFT specialist, ACT specialist, supportive counselor, behavior management specialist and/or assistant, nurse, psychologist and/or the psychiatrist, as well as the member and/or designated legal representative. If there is an outside agency involved in the provision of treatment services, a representative of this service is optimal as well. It should be documented that a representative from the outside agency service is invited to attend the service plan meeting.
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37. How do you know at intake whether the member will need focused or coordinated care?

Since the clinician conducting the intake is required to make treatment recommendations, the clinician should begin with the lowest level of services that can be safely provided and progress later to more intensive services if needed. The clinician should also utilized clinical supervision as issues arise.
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38. Have the minimum degree requirements for supportive counselors changed?

Yes, new hires must have a bachelor’s degree in a human services field. Current supportive counselors will need to have earned a bachelor’s degree by January 2018.
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39. Will current supportive counselors without a B.A. be “grandfathered in” and exempt from the requirement of a B.A. degree?

No. Current supportive counselors without the minimum of a B.A. will not be credentialed to provide supportive counseling as of January 1, 2018.
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40. Can the minimum therapy requirements be exceeded during the phases of NMMAT?

Yes. As long as medical necessity is present for the frequency of visits provided, therapy can exceed the minimum standards in any phase of NMMAT.
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41. Is an LPN required at all times (24/7) to provide crisis stabilization services?

Yes, two staff is required at all times. One person must be at minimum an LPN, and one person may have at minimum a High School Diploma or equivalent with training in systematic de-escalation and with the targeted population.
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42. ACT services require that 75% of services take place in the community. Are provider buildings other than the main office location considered in the community?

Yes, any location outside of the main office is considered to be a community site.
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43. If a member is receiving focused services (professional therapy and medication management) and they begin receiving supportive counseling, are they considered as receiving coordinated service?

Yes. If they meet medical necessity for needing supportive counseling, they will at that point be receiving coordinated services. (A notation in the case file must be made when switching levels of service along with the reasons for the change.)
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44. Can a group (Professional or Supportive Counseling) ever exceed 12 members?

No, WV Medicaid indicates the maximum number of group members is 12.
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45. Do national background checks have to be done every three years?

Yes. BMS is currently working on a wraparound system that will automatically update criminal background fingerprint checks. Until that time, it is the responsibility of the provider to update their checks every 3 years.
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46. On page 24 of the WV Medicaid Rehabilitation Manual it indicates, “All Service Plans (including updates) must be reviewed, signed, and approved by a physician within 72 hours of the service plan meeting and prior to implementing services.” It says physician there, but underneath in the following paragraph it allows the physician, designated physician extender, or licensed or supervised psychologist to sign the plan, which is it?

The Rehabilitation manual allows the physician/physician extender, licensed psychologist and supervised psychologist to approve the plan. The sentence quoted above applies to clinic services rather than rehabilitation and will be removed from the Rehabilitation manual and reposted.
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47. When would an additional H0031 (Mental Health Assessment by Non-Physician) be required??

A new H0031 would only be done when medically necessary to do so. The manual specifies the following approved causes:

Approved Causes For Utilization:

  1. Intake/Initial evaluation;

  2. Alteration in level of care with the exception of individuals being stepped down related to function of their behavioral Health condition to a lesser level of care.

  3. Critical treatment juncture, defined as: The occurrence of an unusual or significant event which has an impact on the process of treatment. A critical treatment juncture will result in a documented meeting between the provider and the member and/or DLR and may cause a revision of the plan of services;

  4. Readmission upon occurrence of unusual or significant events that justify the re-initiation of treatment or that have had an impact on the individual’s willingness to accept treatment;

  5. No one under the age of three (3) will have a H0031 conducted on them. The Medicaid member under the age of the 3 should be referred to the Birth to Three Program.

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48. When would the Global Assessment need to be redone?

The provider may request authorization to conduct one global assessment per year to reaffirm medical necessity and the need for continued care/services.
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49. What do you mean by the ‘Gold Card’?

Once approved for supervision, the supervised psychologist will be issued a “Gold Card” by the WV Board of Examiners for Psychologists, which denotes that they are a Board Approved Supervised Psychologist. Some Gold Cards were issued to interns who do not yet hold a Master’s degree. The agency must ensure that the supervised psychologist has actually obtained their Master’s Degree prior to delivery of Medicaid billable services.
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50. Do we have to get pre-authorizations for medication management?

Medication management codes do not require prior authorization through the ASO.
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51. Comprehensive Community Support Services requires a roster with location and staff ratio. If the services start in the agency but then later move into a community setting does it require two separate rosters or can the second location just be noted in the treatment notes?

When changing locations from agency to community or vice versa, a roster must specify the location change and the staff ratio as different ratios are required based on location.
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52. If a psychotropic medication is prescribed by an outside physician or agency, does the physician or psychologist have to attend the service plan meeting?

WV Medicaid does not require that the physician or psychologist attend the service plan meeting if the psychotropic medication is prescribed by an outside entity. However, there are other conditions for which the physician or psychologist must be in attendance.
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53. If a physician contracts with the agency but prescribes psychotropic medication through his/her own practice, would they need to attend the agency service plan meeting?

If the physician bills the medication service through their own practice and not through the agency, then the physician service would be considered external to the agency and the physician would not be required to attend the service plan meeting unless the other conditions for attendance are met.
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54. Does the whole team need to be present for the service plan reviews?

Yes.
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55. Is there a list of eligible diagnosis for Clinic vs. Rehabilitation services?

The majority of diagnosis can be considered clinic or rehabilitation eligible. However, if the diagnosis is I/DD only, the individual may only receive clinic services.
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56. ACT service requires a medication delivery policy. Does this policy apply to all members or just to the members to whom you are delivering their medications?

The policy only applies to members receiving medication delivery.
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57. Does ACT require there to be an average of 2 hours of services to each member per week?

No. ACT requires there to be 2 face to face contacts per week and 4 total contacts per week.
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58. Who must attend an initial service plan?

All treatment team members or their representatives must attend all service plan meetings.
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59. Are medication management services still part of the residential bundle or is it now billed separately since it is no longer authorized through behavioral health services?

The services included within each bundle have not changed. Regardless of requiring authorization, any service identified as being included in the bundle must be covered within the existing payment.
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60. Where does the physician or provider sign the Coordination of Care and Release of Information Form for NMMAT?

The prescribing physician, the behavioral health provider, and the member should all sign the last page (page 4) of the agreement.
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61. If the registered nurse is being used for the H0031, can they be supervised by a LSW?

Each agency is required to develop credentialing policies and supervision policies. The supervising staff must have an equal or higher degree, credential, and/or experience than those they are supervising. Supervision of an RN may need to be based on their scope of practice and licensure requirements. If the RN has psych training and/or psych certification then no supervision would be necessary. If the BSN has psych training and/or psych certification they could supervise.
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62. Can the H0031 and 90791 be billed on the same day if a H0031 is completed and it is determined that a 90791 is needed immediately?

No. CPT service edits prohibit any other evaluative service to be paid on the same day as the 90791.
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63. Does HB4208 change the Non-Methadone Policy in the WV Clinic and Rehabilitation Manuals?

Yes. Providers should disregard the following statement in Chapters 502 and 503: “Agencies should be aware that West Virginia law forbids the use of Buprenorphine/Naltrexone in tablet form for the treatment of substance use disorders.” The Bureau for Medical Services will remove this statement when the manuals are scheduled for updating in 2016. You may access HB4208 for additional information by clicking here.
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Revised July 2014

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