Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 19 - Aging and Adult Services › Rule 016.19.18-003 - Outpatient Behavioral Health Services Program Provider Manual 3-18 and Certification Manual

Current through Register Vol. 49, No. 6, June, 2024
Section II
Outpatient Behavioral Health Services
200.000
OUTPATIENT BEHAVIORAL HEALTH
			 SERVICES GENERAL INFORMATION
201.000
Introduction 1-1-19
Medicaid (Medical Assistance) is designed to assist eligible
				Medicaid beneficiaries in obtaining medical care within the guidelines
				specified in Section I of this manual. Outpatient Behavioral Health Services
				are covered by Medicaid when provided to eligible Medicaid beneficiaries by
				enrolled providers.
Outpatient Behavioral Health Services may be provided to
				eligible Medicaid beneficiaries at all provider certified/enrolled sites.
				Allowable places of service are found in the service definitions located in
				Section 252 and Section 255 of this manual.
202.000
Arkansas Medicaid Participation
			 Requirements for Outpatient 1-1-19
Behavioral Health Services
All behavioral health providers approved to receive Medicaid
				reimbursement for services to Medicaid beneficiaries must meet specific
				qualifications for their services and staff. Providers with multiple service
				sites must enroll each site separately and reflect the actual service site on
				billing claims.
Behavioral Health Providers must meet the Provider
				Participation and enrollment requirements contained within Section 140.000 of
				this manual as well as the following criteria to be eligible to participate in
				the Arkansas Medicaid Program:
A.
			 Providers must be located within the State of Arkansas.
B. A provider must be certified by the
			 Division of Provider Services and Quality Assurance (DPSQA). (See Section
			 202.100 for specific certification requirements.)
C. A copy of the current DPSQA certification
			 as a Behavioral Health provider must accompany the provider application and
			 Medicaid contract.
D. The provider
			 must give notification to the Office of the Medicaid Inspector General (OMIG)
			 on or before the tenth day of each month of all covered health care
			 practitioners who perform services on behalf of the provider. The notification
			 must include the following information for each covered health care
			 practitioner:
1. Name/Title
2. Enrolled site(s) where services are
			 performed
3. Social Security
			 Number
4. Date of Birth
5. Home Address
6. Start Date
7. End Date (if applicable)
Notification is not required when the list of covered health
				care practitioners remains unchanged from the previous notification.
DMS shall exclude providers for the reasons stated in
				42 U.S.C. §
												1320a-7(a) and implementing
				regulations and may exclude providers for the reasons stated in
				42 U.S.C. §
												1320a-7(b) and implementing
				regulations.
The following factors shall be considered by DHS in
				determining whether sanction(s) should be imposed:
A. Seriousness of the offense(s)
B. Extent of violation(s)
C. History of prior violation(s)
D. Whether an indictment or information was
			 filed against the provider or a related party as defined in DHS Policy 1088,
			 titled DHS Participant Exclusion Rule.
202.100
Certification Requirements by
			 the Division of Provider Services and 1-1-19
Quality Assurance (DPSQA)
In order to enroll into the Outpatient Behavioral Health
				Services Medicaid program as a Performing Provider or Group for Counseling
				Services or a Behavioral Health Agency, all performing providers, provider
				groups, and business entities participating in the Medicaid Outpatient
				Behavioral Health Services (OBH) Program must be certified by the Division of
				Provider Services and Quality Assurance. The DPSQA Certification Rules for
				Providers of Outpatient Behavioral Health Services is located at
http://humanservices.arkansas.gov/dbhs/Pages/dbhs_docs.aspx
.
Behavioral Health Agencies must have national accreditation
				that recognizes and includes all of the applicant's programs, services and
				service sites. Any outpatient behavioral health program service site associated
				with a hospital must have a free-standing behavioral health outpatient program
				national accreditation. Providers must meet all other DPSQA certification
				requirements in addition to accreditation.
210.000
PROGRAM
			 COVERAGE
211.000
Coverage of Services 1-1-19
Outpatient Behavioral Health Services are limited to certified
				providers who offer core behavioral health services for the treatment of
				behavioral disorders. All performing providers, provider groups, and business
				entities participating in the Medicaid Outpatient Behavioral Health Services
				(OBH) Program must be certified by the Division Provider Services and Quality
				Assurance.
An Outpatient Behavioral Health Services provider must
				establish a site specific emergency response plan that complies with the DPSQA
				Certification Rules for Providers of Outpatient Behavioral Health Services.
				Each agency site must have 24-hour emergency response capability to meet the
				emergency treatment needs of the Behavioral Health Services beneficiaries
				served by the site. The provider must implement and maintain a written policy
				reflecting the specific coverage plan to meet this requirement. A machine
				recorded voice mail message to call 911 or report to the nearest emergency room
				in and of itself is not sufficient to meet the requirement.
Licensed performing providers as certified by DPSQA must also
				maintain an Emergency Service Plan that complies with the DPSQA Certification
				Rules for Providers of Outpatient Behavioral Health Services manual.
All Outpatient Behavioral Health Services providers must
				demonstrate the capacity to provide effective, equitable, understandable, and
				respectful quality care and services that are responsive to diverse cultural
				health beliefs and practices, preferred languages, health literacy and other
				communication needs.
211.100
Quality Assurance 1-1-19
Each Behavioral Health Agency must establish and maintain a
				quality assurance committee that will meet quarterly and examine the clinical
				records for completeness, adequacy and appropriateness of care, quality of care
				and efficient utilization of provider resources. The committee must also comply
				with the DPSQA Certification Rules for Providers of Outpatient Behavioral
				Health Services manual. Documentation of quality assurance committee meetings
				and quality improvement programs must be filed separately from the clinical
				records.
211.200
Staff Requirements 1-1-19
Each Outpatient Behavioral Health Services provider must ensure
				that they employ staff which is able and available to provide appropriate and
				adequate services offered by the provider. Behavioral Health staff members must
				provide services only within the scope of their individual licensure. The
				following chart lists the terminology used in this provider manual and explains
				the licensure, certification and supervision that are required for each
				performing provider type.
PROVIDER TYPE
LICENSES
STATE CERTIFICATION REQUIRED
SUPERVISION
Independently Licensed Clinicians -
						  Master's/Doctoral
Licensed Clinical Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner - Independent
						  (LPEI)
Licensed Professional Counselor (LPC)
Yes, must be certified to provide services
Not Required
Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
Licensed Clinical Social Worker (LCSW)
Licensed Marital and Family Therapist (LMFT)
Licensed Psychologist (LP)
Licensed Psychological Examiner - Independent
						  (LPEI)
Licensed Professional Counselor (LPC)
Yes, must be certified to provide services
Not Required
Non-independently Licensed Clinicians -
						  Master's/Doctoral
Licensed Master Social Worker (LMSW)
Licensed Associate Marital and Family Therapist
						  (LAMFT)
Licensed Associate Counselor (LAC)
Licensed Psychological Examiner (LPE)
Provisionally Licensed Psychologist (PLP)
Yes, must be supervised by appropriate Independently
						  Licensed Clinician
Required
Non-independently Licensed Clinicians -
						  Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
Licensed Master Social Worker (LMSW)
Licensed Associate Counselor (LAC)
Licensed Psychological Examiner (LPE)
Provisionally Licensed Psychologist (PLP)
Yes, must be supervised by appropriate Independently
						  Licensed Clinician and must be certified to provide services
Required
Advanced Practice Nurse (APN)
Adult Psychiatric Mental Health Clinical Nurse
						  Specialist
Child Psychiatric Mental Health Clinical Nurse
						  Specialist
Adult Psychiatric Mental Health APN
Family Psychiatric Mental Health APN
No, must be part of a certified agency or have a
						  Collaborative Agreement with a Physician
Collaborative Agreement with Physician Required
Physician
Doctor of Medicine (MD)
Doctor of Osteopathic Medicine (DO)
No, must provide proof of licensure
Not Required
The services of a medical records librarian are required. The
				medical records librarian (or person performing the duties of the medical
				records librarian) shall be responsible for ongoing quality controls, for
				continuity of patient care and patient traffic flow. The librarian shall assure
				that records are maintained, completed and preserved; that required indexes and
				registries are maintained and that statistical reports are prepared. This staff
				member will be personally responsible for ensuring that information on enrolled
				patients is immediately retrievable, establishing a central records index, and
				maintaining service records in such a manner as to enable a constant monitoring
				of continuity of care.
When an Outpatient Behavioral Health Services provider files a
				claim with Arkansas Medicaid, the staff member who actually performed the
				service must be identified on the claim as the rendering provider. This action
				is taken in compliance with the federal Improper Payments Information Act of
				2002 (IPIA),
				Public
				Law 107-300 and the resulting Payment Error Rate
				Measurement (PERM) program initiated by the Centers for Medicare and Medicaid
				Services (CMS).
211.300
Certification of Performing Providers 1-1-19
As illustrated in the chart in § 211.200, certain
				Outpatient Behavioral Health performing providers are required to be certified
				by the Division Provider Services and Quality Assurance. The certification
				requirements for performing providers are located on the DPSQA website at
http://humanservices.arkansas.gov/dbhs/Pages/dbhs_docs.aspx
.
211.500
Non-Refusal
			 Requirement 1-1-19
The Outpatient Behavioral Health Services provider may not
				refuse services to a Medicaid-eligible beneficiary who meets the requirements
				for Outpatient Behavioral Health Services as outlined in this manual. If a
				provider does not possess the services or program to adequately treat the
				beneficiary's behavioral health needs, the provider must communicate this with
				the Primary Care Physician (PCP) or Patient-Centered Medical Home (PCMH) for
				beneficiaries receiving Counseling Services so that appropriate provisions can
				be made.
212.000
Scope 1-1-19
The Outpatient Behavioral Health Services Program provides
				care, treatment and services which are provided by a certified Behavioral
				Health Services provider to Medicaid-eligible beneficiaries that have a
				Behavioral Health diagnosis as described in the American Psychiatric
				Association Diagnostic and Statistical Manual (DSM-5 and subsequent
				revisions).
Eligibility for services depends on the needs of the
				beneficiary. Counseling Level Services and Crisis Services can be provided to
				any beneficiary as long as the services are medically necessary
COUNSELING LEVEL SERVICES
Time-limited behavioral health services provided by qualified
				licensed practitioners in an outpatient-based setting for the purpose of
				assessing and treating mental health and/or substance abuse conditions.
				Counseling Services settings shall mean a behavioral health clinic/office,
				healthcare center, physician office, child advocacy center, home, shelter,
				group home, and/or school.
213.000
Outpatient Behavioral Health
			 Services Program Entry 1-1-19
Prior to continuing provision of Counseling Level Services, the
				provider must document medical necessity of Outpatient Behavioral Health
				Counseling Services. The documentation of medical necessity is a written intake
				assessment that evaluates the beneficiary's mental condition and, based on the
				beneficiary's diagnosis, determines whether treatment in the Outpatient
				Behavioral Health Services Program is appropriate. This documentation must be
				made part of the beneficiary's medical record.
The intake assessment , either the Mental Health Diagnosis (CPT
				Code 90791), Substance Abuse Assessment (CPT Code H0001), or Psychiatric
				Assessment (CPT Code 90792), must be completed prior to the provision of
				Counseling Level Services in the Outpatient Behavioral Health Services program.
				This intake will assist providers in determining services needed and desired
				outcomes for the beneficiary. The intake must be completed by a mental health
				professional qualified by licensure and experienced in the diagnosis and
				treatment of behavioral health and/or substance use disorders.
213.100
Independent
			 Assessment Referral 1-1-19
Please refer to the Independent Assessment Manual or the PASSE
				Manual for Independent Assessment Referral Process.
214.000
Role of Providers of Counseling
			 Level Services 1-1-19
Outpatient Behavioral Health Providers provide Counseling Level
				Services by qualified licensed practitioners in an outpatient based setting for
				the purpose of assessing and treating behavioral health conditions. Counseling
				Level Services outpatient based setting shall mean services rendered in a
				behavioral health clinic/ office, healthcare center, physician office, home,
				shelter, group home, and/or school. The performing provider must provide
				services only within the scope of their individual licensure. Services
				available to be provided by Counseling Level Services providers are listed in
				Section 252.111 through 255.001 of the Outpatient Behavioral Health Services
				manual.
214.100
Parent/Caregiver & Child (Dyadic treatment of Children age 0-47
			 months & Parent/Caregiver) 1-1-19
Outpatient Behavioral Health Providers may provide dyadic
				treatment of beneficiary's age 0-47 months and the parent/caregiver of the
				eligible beneficiary. A prior authorization will be required for all dyadic
				treatment services (the Mental Health Diagnosis and Interpretation of Diagnosis
				DO NOT require a prior authorization). All performing providers of
				parent/caregiver and child Outpatient Behavioral Health Services MUST be
				certified by DAABHS to provide those services.
Providers will diagnose children through the age of 47 months
				based on the DC: 0-3R. Providers will then crosswalk the DC: 0-3R diagnosis to
				a DMS diagnosis. Specified V codes will be allowable for this
				population.
217.100
Primary Care Physician (PCP) Referral 1-1-19
Each beneficiary that receives only Counseling Level Services
				in the Outpatient Behavioral Health Services program can receive a limited
				amount of Counseling Level Services. Once those limits are reached, a Primary
				Care Physician (PCP) referral or PCMH approval will be necessary to continue
				treatment. This referral or approval must be retained in the beneficiary's
				medical record.
A beneficiary can receive three (3) Counseling Level services
				before a PCP/PCMH referral is necessary. Crisis Intervention (Section 255.001)
				does not count toward the three (3) counseling level services. No services,
				except Crisis Intervention, will be allowed to be provided without appropriate
				PCP/PCMH referral. The PCP/PCMH must be kept in the beneficiary's medical
				record.
The Patient Centered Medical Home (PCMH) will be responsible
				for coordinating care with a beneficiary's PCP or physician for Counseling
				Level Services. Medical responsibility for beneficiaries receiving Counseling
				Level Services shall be vested in a physician licensed in Arkansas.
The PCP referral or PCMH authorization for Counseling Level
				Services will serve as the prescription for those services.
Verbal referrals from PCPs or PCMHs are acceptable to Medicaid
				as long as they are documented in the beneficiary's chart as described in
				Section 171.410.
See Section I of this manual for an explanation of the process
				to obtain a PCP referral.
219.200
Telemedicine (Interactive
			 Electronic Transactions) Services 1-1-19
See Section I for Telemedicine policy and Section III for
				Telemedicine billing protocol.
220.000
Inpatient Hospital Services
			 1-1-19
Regulation for Inpatient Hospital Services may be found in
				program specific manuals located at:
https://medicaid.mmis.arkansas.gov/Provider/Docs/Docs.aspx
223.000
Exclusions
			 1-1-19
Services not covered under the Outpatient Behavioral Health
				Program include, but are not limited to:
A. Room and board residential costs
B. Educational services
C. Telephone contacts with patient
D. Transportation services, including time
			 spent transporting a beneficiary for services
(reimbursement for other
			 Outpatient Behavioral Health services is not allowed for the period of time the
			 Medicaid beneficiary is in transport)
E. Services to individuals with developmental
			 disabilities that are non-psychiatric in nature
F. Services which are found not to be
			 medically necessary
G. Services
			 provided to nursing home and ICF/IDD residents other than those specified in
			 the applicable populations sections of the service definitions in this
			 manual
224.000
Physician's Role 1-1-19
Certified Counseling Level Services providers must have
				relationships with a physician licensed in Arkansas in order to ensure
				psychiatric and medical conditions are monitored and addressed by appropriate
				physician oversight.
Medical supervision responsibility shall include, but is not
				limited to, the following:
A. A
			 beneficiary can receive three (3) Counseling Level Services before a PCP/PCMH
			 referral is necessary in the medical record (see Section 217.100). Medical
			 responsibility will be vested in a physician licensed in Arkansas who signs the
			 PCP referral or PCMH approval for Counseling Level Services of the Outpatient
			 Behavioral Health Services program.
227.000
Prescription for Outpatient
			 Behavioral Health Services 1-1-19
Each beneficiary that receives only Counseling Level Services
				can receive a limited amount of Counseling Level Services without a Primary
				Care Physician (PCP) referral or Patient-Centered Medical Home (PCMH) approval.
				Once those limits are reached, a PCP referral or PCMH approval will be
				necessary. This approval by the PCP or PCMH will serve as the prescription for
				Counseling Level Services in the Outpatient Behavioral Health Services program.
				Please see Section 217.100 for limits. Medicaid will not cover any service
				outside of the established limits without a current prescription signed by the
				PCP or PCMH.
Prescriptions shall be based on consideration of an evaluation
				of the enrolled beneficiary. The prescription of the services and subsequent
				renewals must be documented in the beneficiary's medical record.
228.114
Cases Chosen for
			 Review 1-1-19
The contractor will review twenty (20) randomly selected cases
				during the IOC review. If a provider has fewer than 20 open cases, all cases
				shall be reviewed.
The review period shall be specified in the provider
				notification letter. The list of cases to be reviewed shall be given to the
				provider upon arrival or chosen by the IOC Team from a list for the provider
				site. The components of the records required for review include:
A. All required assessments
B. Progress notes, including physician
			 notes
C. Physician orders and lab
			 results
D. Copies of records. The
			 reviewer shall retain a copy of any record reviewed.
228.120
DMS/DBHS Work Group Reports and
			 Recommendations 1-1-19
The DMS/DAABHS Work Group (comprised of representatives from
				the Behavioral Health Unit, the Arkansas Office of Medicaid Inspector General,
				the Division of Aging Adult and Behavioral Health Services (DAABHS), the
				Division of Provider Services and Quality Assurance, the utilization review
				agency, as well as other units or divisions as required) will meet monthly to
				discuss IOC reports.
If a deficiency related to safety or potential risk to the
				beneficiary or others is found, then the utilization review agency shall
				immediately report this to the DMS Director (or the Director's
				designee).
228.121
Corrective Action Plans 1-1-19
The provider must submit a Corrective Action Plan designed to
				correct any deficiency noted in the written report of the IOC. The provider
				must submit the Corrective Action Plan to the contracted utilization review
				agency within 30 calendar days of the date of the written report. The
				contractor shall review the Corrective Action Plan and forward it, with
				recommendations, to the DMS Behavioral Health Unit, the Arkansas Office of
				Medicaid Inspector General and Division of Provider Services and Quality
				Assurance (DPSQA).
After acceptance of the Corrective Action Plan, the utilization
				review agency will monitor the implementation and effectiveness of the
				Corrective Action Plan via on-site review. DMS, its contractor(s) or both may
				conduct a desk review of beneficiary records. The desk review will be
				site-specific and not by organization. If it is determined that the provider
				has failed to meet the conditions of participation, DMS will determine if
				sanctions are warranted.
228.122
Actions 1-1-19
Actions that may be taken following an inspection of care
				review include, but are not limited to:
A. Decertification of any beneficiary
			 determined as not meeting medical necessity criteria for outpatient mental
			 health services
B. Decertification
			 of any provider determined to be noncompliant with the Division of Provider
			 Services and Quality Assurance (DPSQA) provider certification rules
C. On-site monitoring by the utilization
			 review agency to verify the implementation and effectiveness of corrective
			 actions
D. The contractor may
			 recommend, and DMS may require, follow-up inspections of care and/or desk
			 reviews. Follow-up inspections may review the issues addressed by the
			 Corrective Action Plans or may be a complete re-inspection of care, at the sole
			 discretion of the Division of Medical Services
E. Review and revision of the Corrective
			 Action Plan
F. Review by the
			 Arkansas Office of Medicaid Inspector General
G. Formulation of an emergency transition
			 plan for beneficiaries including those in custody of DCFS and DYS
H. Suspension of provider referrals
I. Placement in high priority
			 monitoring
J. Mandatory monthly
			 staff training by the utilization review agency
K. Provider requirement for one of the
			 following staff members to attend a DMS/DAABHS monthly work group meeting:
			 Clinical Director/Designee (at least a master's level mental health
			 professional) or Executive Officer
L. Recoupment for services that are not
			 medically necessary or that fail to meet professionally recognized standards
			 for health care
M. Any sanction
			 identified in Section 152.000
228.132
Review Sample and the Record
			 Request 1-1-19
On a calendar quarterly basis, the contractor will select a
				statistically valid random sample from an electronic data set of all Outpatient
				Behavioral Health beneficiaries whose dates of service occurred during the
				three-month selection period. If a beneficiary was selected in any of the three
				calendar quarters prior to the current selection period, then they will be
				excluded from the sample and an alternate beneficiary will be substituted. The
				utilization review process will be conducted in accordance with
				42 CFR §
											456.23.
A written request for medical record copies will be mailed to
				each provider who provided services to the beneficiaries selected for the
				random sample along with instructions for submitting the medical record. The
				request will include the beneficiary's name, date of birth, Medicaid
				identification number and dates of service. The request will also include a
				list of the medical record components that must be submitted for review. The
				time limit for a provider to request reconsideration of an adverse
				action/decision stated in § 1 of the Medicaid Manual shall be the time
				limit to furnish requested records. If the requested information is not
				received by the deadline, a medical necessity denial will be issued.
All medical records must be submitted to the contractor via
				fax, mail or electronic medium.
View or print current
				contractor contact information.
." Records will not be
				accepted via email.
228.133
Review Process 1-1-19
The record will be reviewed using a review tool based upon the
				promulgated Medicaid Outpatient Behavioral Health Services manual. The review
				tool is designed to facilitate review of regulatory compliance, incomplete
				documentation and medical necessity. All reviewers must have a professional
				license in therapy (LCSW, LMSW, LPE, LPE-I, LPC, LAC, LMFT, LAMFT, etc.). The
				reviewer will screen the record to determine whether complete information was
				submitted for review. If it is determined that all requested information was
				submitted, then the reviewer will review the documentation in more detail to
				determine whether it meets medical necessity criteria based upon the reviewer's
				professional judgment.
If a reviewer cannot determine that the services were medically
				necessary, then the record will be given to a psychiatrist for review. If the
				psychiatrist denies some or all of the services, then a denial letter will be
				sent to the provider and the beneficiary. Each denial letter contains a
				rationale for the denial that is record specific and each party is provided
				information about requesting reconsideration review or a fair hearing.
The reviewer will also compare the paid claims data to the
				progress notes submitted for review. When documentation submitted does not
				support the billed services, the reviewer will deny the services which are not
				supported by documentation. If the reviewer sees a deficiency during a
				retrospective review, then the provider will be informed that it has the
				opportunity to submit information that supports the paid claim. If the
				information submitted does not support the paid claim, the reviewer will send a
				denial letter to the provider and the beneficiary. Each denial letter contains
				a rationale for the denial that is record-specific and each party is provided
				information about requesting reconsideration review or a fair hearing.
Each retrospective review, and any adverse action resulting
				from a retrospective review, shall comply with the Medicaid Fairness Act. DMS
				will ensure that its contractor(s) is/are furnished a copy of the Act.
231.100
Prior Authorization
			 1-1-19
Prior Authorization is required for certain Outpatient
				Behavioral Health Services provided to Medicaid-eligible beneficiaries.
Prior Authorization requests must be sent to the DMS contracted
				entity to perform prior authorizations for beneficiaries under the age of 21
				and for beneficiaries age 21 and over for services that require a Prior
				Authorization.
View or print current contractor contact
				information.
Information related to clinical management
				guidelines and authorization request processes is available at
current
				contractor's website
.
Procedure codes requiring prior
				authorization:
National Codes
Required Modifier
Service Title
90832
UC, UK, U4
Individual Behavioral Health Counseling - Age 3
90834
UC, UK U4
Individual Behavioral Health Counseling - Age 3
90837
UC, UK, U4
Individual Behavioral Health Counseling - Age 3
90847
UC, UK, U4
Marital/Family Behavioral Health Counseling with
						  Beneficiary Present - Dyadic Treatment
H2027
UK, U4
Psychoeducation - Dyadic Treatment
231.300
Substance Abuse Covered Codes
Certain Outpatient Behavioral Health Services are covered by
				Arkansas Medicaid for an individual whose primary diagnosis is substance abuse.
				Independently Licensed Practitioners may provide Substance Abuse Service within
				the scope of their practice. Behavioral Health Agency sites must be licensed by
				the Divisions of Provider Services and Quality Assurance in order to provide
				Substance Abuse Services. Allowable substance abuse services are listed
				below:
National Codes
Required Modifier
Service Title
90832
U4 U5
Individual Behavioral Health Counseling - Substance
						  Abuse
90834
U4 U5
Individual Behavioral Health Counseling - Substance
						  Abuse
90837
U4 U5
Individual Behavioral Health Counseling - Substance
						  Abuse
90853
U4 U5
Group Behavioral Health Counseling - Substance
						  Abuse
90846
U4 U5
Marital/Family Behavioral Health Counseling - without
						  Beneficiary Present - Substance Abuse
90847
U4 U5
Marital/Family Behavioral Health Counseling with
						  Beneficiary Present - Substance Abuse
90849
U4 U5
Multi-Family Behavioral Health Counseling - Substance
						  Abuse
90791
Mental Health Diagnosis
90887
Interpretation of Diagnosis
H0001
U4
Substance Abuse Assessment
Beneficiaries being treated by an Outpatient Behavioral Health
				Service provider for a mental health disorder who also have a co-occurring
				substance use disorder(s), this (these) substance use disorder(s) is (are)
				listed as a secondary diagnosis. Outpatient Behavioral Health Service Agency
				providers that are certified to provide Substance Abuse services may also
				provider substance abuse treatment to their behavioral health clients. In the
				provision of Outpatient Behavioral Health mental health services, the substance
				use disorder is appropriately focused on with the client in terms of its impact
				on and relationship to the primary mental health disorder.
A Behavioral Health Agency and Independently Licensed
				Practitioner may provide substance abuse treatment services to beneficiaries
				who they are also providing mental health/behavioral health services to. In
				this situation, the substance abuse disorder must be listed as the secondary
				diagnosis on the claim with the mental health/behavioral health diagnosis as
				the primary diagnosis.
240.100 Reimbursement 1-1-19
Reimbursement is based on the lesser of the billed amount or
				the Title XIX (Medicaid) maximum allowable for each procedure.
Reimbursement is contingent upon eligibility of both the
				beneficiary and provider at the time the service is provided and upon accurate
				completeness of the claim filed for the service. The provider is responsible
				for verifying that the beneficiary is eligible for Arkansas Medicaid prior to
				rendering services.
A. Outpatient
			 Services
Fifteen-Minute Units, unless otherwise stated
Outpatient Behavioral Health Services must be billed on a per
				unit basis as indicated in the service definition, as reflected in a daily
				total, per beneficiary, per service.
Time spent providing services for a single beneficiary may be
				accumulated during a single, 24-hour calendar day. Providers may accumulatively
				bill for a single date of service, per beneficiary, per Outpatient Behavioral
				Health service. Providers are not allowed to accumulatively bill for spanning
				dates of service.
All billing must reflect a daily total, per Outpatient
				Behavioral Health service, based on the established procedure codes. No
				rounding is allowed.
The sum of the days' time, in minutes, per service will
				determine how many units are allowed to be billed. That number must not be
				exceeded. The total of minutes per service must be compared to the following
				grid, which determines the number of units allowed.
15 Minute Units
Timeframe
One (1) unit =
8-24 minutes
Two (2) units =
25 -39 minutes
Three (3) units =
40 - 49 minutes
Four (4) units =
50 - 60 minutes
60 minute Units
Timeframe
One (1) unit =
50-60 minutes
Two (2) units =
110-120 minutes
Three (3) units =
170-180 minutes
Four (4) units =
230-240 minutes
Five (5) units =
290-300 minutes
Six (6) units =
350-360 minutes
Seven (7) units=
410-420 minutes
Eight (8) units=
470-480 minutes
In a single claim transaction, a provider may bill only for
				service time accumulated within a single day for a single beneficiary. There is
				no "carryover" of time from one day to another or from one beneficiary to
				another.
Documentation in the beneficiary's record must reflect exactly
				how the number of units is determined.
No more than four (4) units may be billed for a single hour per
				beneficiary or provider of the service.
B. Inpatient Services
The length of time and number of units that may be billed for
				inpatient hospital visits are determined by the description of the service in
Current Procedural Terminology (CPT).
241.000
Fee
			 Schedule 1-1-19
Arkansas Medicaid provides fee schedules on the Arkansas
				Medicaid website. The fee schedule link is located at
https://medicaid.mmis.arkansas.gov/Provider/Docs/fees.aspx
under the provider manual section. The fees represent the fee-for-service
				reimbursement methodology.
Fee schedules do not address coverage limitations or special
				instructions applied by Arkansas Medicaid before final payment is
				determined.
Procedure codes and/or fee schedules do not guarantee payment,
				coverage or amount allowed. Information may be changed or updated at any time
				to correct a discrepancy and/or error. Arkansas Medicaid always reimburses the
				lesser of the amount billed or the Medicaid maximum.
252.100
Procedure Codes for Types of
			 Covered Services 1-1-19
Covered Behavioral Health Services are outpatient services.
				Specific Behavioral Health Services are available to inpatient hospital
				patients (as outlined in Sections 240.000 and 220.100), through telemedicine,
				and to nursing home residents. Outpatient Behavioral Health Services are billed
				on a per unit or per encounter basis as listed. All services must be provided
				by at least the minimum staff within the licensed or certified scope of
				practice to provide the service.
Benefits are separated by Level of Service. A beneficiary can
				receive three (3) Counseling Level Services before a PCP/PCMH referral is
				necessary in the medical record.
The allowable services differ by the age of the beneficiary and
				are addressed in the Applicable Populations section of the service definitions
				in this manual.
252.111
Individual Behavioral Health Counseling 1-1-19
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90832, U4
90832: psychotherapy, 30 min
90834, U4
90834: psychotherapy, 45 min
90837, U4
90832, U4, GT - Telemedicine
90834, U4, GT - Telemedicine
90837, U4, GT - Telemedicine
90832, U4, U5 - Substance Abuse
90834, U4, U5 - Substance Abuse
90837, U4, U5 - Substance Abuse
90832, UC, UK, U4 - Under Age 4
90834, UC, UK, U4 - Under Age 4
90837, UC, UK, U4 - Under Age 4
90837: psychotherapy, 60 min
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Individual Behavioral Health Counseling is a
						  face-to-face treatment provided to an individual in an outpatient setting for
						  the purpose of treatment and remediation of a condition as described in the
						  current allowable DSM. The treatment service must reduce or alleviate
						  identified symptoms related to either (a) Mental Health or (b) Substance Abuse,
						  and maintain or improve level of functioning, and/or prevent deterioration.
						  Additionally, tobacco cessation counseling is a component of this
						  service.
* Date of Service
* Start and stop times of face-to-face encounter with
						  beneficiary
* Place of service
* Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale and description of the treatment used that
						  must coincide with Mental Health Diagnosis
* Beneficiary's response to treatment that includes
						  current progress or regression and prognosis
* Any revisions indicated for the diagnosis, or
						  medication concerns
* Plan for next individual therapy session, including
						  any homework assignments and/or advanced psychiatric directive or crisis
						  plans
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
Services provided must be congruent with the objectives
						  and interventions articulated on the most recent Mental Health Diagnosis.
						  Services must be consistent with established behavioral healthcare standards.
						  Individual Psychotherapy is not permitted with beneficiaries who do not have
						  the cognitive ability to benefit from the service.
This service is not for beneficiaries under the age of
						  4 except in documented exceptional cases. This service will require a Prior
						  Authorization for beneficiaries under the age of 4.
90832: 30 minutes
90834: 45 minutes
90837: 60 minutes
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
90832: 1
90834: 1
90837: 1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested):
Counseling Level Beneficiary: 12 encounters between all
						  3 codes
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults Residents of Long Term Care
						  Facilities
A provider may only bill one Individual Behavioral
						  Health Counseling Code per day per beneficiary. A provider cannot bill any
						  other Individual Behavioral Health Counseling Code on the same date of service
						  for the same beneficiary. For Counseling Level Beneficiaries, there are 12
						  total individual counseling encounters allowed per year regardless of code
						  billed for Individual Behavioral Health Counseling unless an extension of
						  benefits is allow by the Quality Improvement Organization contracted with
						  Arkansas Medicaid.
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Telemedicine (Adults, Youth, and Children)
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE (POS)
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
* Providers of services for beneficiaries under age 4
						  must be trained and certified in specific evidence based practices to be
						  reimbursed for those services
o Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
o Non-independently Licensed Clinicians -
						  Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office) 12 (Patient's Home), 32 (Nursing Facility), 49 (Independent
						  Clinic), 50 (Federally Qualified Health Center), 53 (Community Mental Health
						  Center), 57 (Non-Residential Substance Abuse Treatment Facility), 71 (Public
						  Health Clinic), 72 (Rural Health Clinic)
252.112
Group Behavioral Health
			 Counseling
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90853, U4
90853, U4, U5 - Substance Abuse
Group psychotherapy (other than of a multiple-family
						  group)
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Group Behavioral Health Counseling is a face-to-face
						  treatment provided to a group of beneficiaries. Services leverage the emotional
						  interactions of the group's members to assist in each beneficiary's treatment
						  process, support his/her rehabilitation effort, and to minimize relapse..
						  Services pertain to a beneficiary's (a) Mental Health and/or (b) Substance
						  Abuse condition. Additionally, tobacco cessation counseling is a component of
						  this service.
Services must be congruent with the age and abilities
						  of the beneficiary, client-centered and strength-based; with emphasis on needs
						  as identified by the beneficiary and provided with cultural competence.
* Date of Service
* Start and stop times of actual group encounter that
						  includes identified beneficiary
* Place of service
* Number of participants
* Diagnosis
* Focus of group
* Brief mental status and observations
* Rationale for group counseling must coincide with
						  Mental Health Assessment
* Beneficiary's response to the group counseling that
						  includes current progress or regression and prognosis
* Any changes indicated for diagnosis, or medication
						  concerns
* Plan for next group session, including any homework
						  assignments and/ or crisis plans
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
This does NOT include psychosocial groups.
						  Beneficiaries eligible for Group Behavioral Health Counseling must demonstrate
						  the ability to benefit from experiences shared by others, the ability to
						  participate in a group dynamic process while respecting the others' rights to
						  confidentiality, and must be able to integrate feedback received from other
						  group members. For groups of beneficiaries aged 18 and over, the minimum number
						  that must be served in a specified group is 2. The maximum that may be served
						  in a specified group is 12. For groups of beneficiaries under 18 years of age,
						  the minimum number that must be served in a specified group is 2. The maximum
						  that may be served in a specified group is 10. A beneficiary must be 4 years of
						  age to receive group therapy. Group treatment must be age and developmentally
						  appropriate, (i.e., 16 year olds and 4 year olds must not be treated in the
						  same group). Providers may bill for services only at times during which
						  beneficiaries participate in group activities.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested):
Counseling Level Beneficiary: 12 encounters
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
A provider can only bill one Group Behavioral Health
						  Counseling encounter per day. For Counseling Level Beneficiaries, there are 12
						  total group behavioral health counseling encounters allowed per year unless an
						  extension of benefits is allowed by the Quality Improvement Organization
						  contracted with Arkansas Medicaid.
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
03 (School), 11 (Office), 49 (Independent Clinic), 49
						  (Independent Clinic), 50 (Federally Qualified Health Center), 53 (Community
						  Mental Health Center), 57 (Non-Residential Substances Abuse Treatment
						  Facility), 71 (Public Health Clinic), 72 (Rural Health Clinic)
252.113
Marital/Family Behavioral
			 Health Counseling with Beneficiary Present
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90847, U4
90847, U4, U5 - Substance Abuse
90847, UC, UK, U4 - Dyadic Treatment
*
Family psychotherapy (conjoint psychotherapy) (with
						  patient present)
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Marital/Family Behavioral Health Counseling with
						  Beneficiary Present is a face-to-face treatment provided to one or more family
						  members in the presence of a beneficiary. Services are designed to enhance
						  insight into family interactions, facilitate inter-family emotional or
						  practical support and to develop alternative strategies to address familial
						  issues, problems and needs. Services pertain to a beneficiary's (a) Mental
						  Health and/or (b) Substance Abuse condition. Additionally, tobacco cessation
						  counseling is a component of this service.
Services must be congruent with the age and abilities
						  of the beneficiary, client-centered and strength-based; with emphasis on needs
						  as identified by the beneficiary and provided with cultural competence.
*Dyadic treatment is available for
						  parent/caregiver & child for dyadic treatment of children age 0 through 47
						  months & parent/caregiver. Dyadic treatment must be prior authorized and is
						  only available for beneficiaries in Tier 1. Dyadic Infant/Caregiver
						  Psychotherapy is a behaviorally based therapy that involves improving the
						  parent-child relationship by transforming the interaction between the two
						  parties.
The primary goal of Dyadic Infant/Parent
						  Psychotherapy is to strengthen the relationship between a child and his or her
						  parent (or caregiver) as a vehicle for restoring the child's sense of safety,
						  attachment, and appropriate affect and improving the child's cognitive,
						  behavioral, and social functioning. This service uses child directed
						  interaction to promote interaction between the parent and the child in a
						  playful manner. Providers must utilize a national recognized evidence based
						  practice. Practices include, but are not limited to, Child-Parent Psychotherapy
						  (CPP) and Parent Child Interaction Therapy (PCIT).
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary and spouse/family
* Place of service
* Participants present and relationship to
						  beneficiary
* Diagnosis and pertinent interval history
* Brief mental status of beneficiary and observations
						  of beneficiary with spouse/family
* Rationale for, and description of treatment used that
						  must coincide with the Mental Health Diagnosis and improve the impact the
						  beneficiary's condition has on the spouse/family and/or improve marital/family
						  interactions between the beneficiary and the spouse/family.
* Beneficiary and spouse/family's response to treatment
						  that includes current progress or regression and prognosis
* Any changes indicated for the diagnosis, or
						  medication concerns
* Plan for next session, including any homework
						  assignments and/or crisis plans
* Staff signature/credentials/date of signature
* HIPAA compliant Release of Information, completed,
						  signed and dated
NOTES
UNIT
BENEFIT LIMITS
Natural supports may be included in these sessions if
						  justified in service documentation and if supported in the documentation in the
						  Mental Health Diagnosis. Only one beneficiary per family per therapy session
						  may be billed.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested):
Counseling Level Beneficiaries: 12 encounters
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
A provider can only bill one Marital / Family
						  Behavioral Health Counseling with (or without) Patient encounter per day. There
						  are 12 total Marital/Family Behavioral Health Counseling with Beneficiary
						  Present encounters allowed per year unless an extension of benefits is allow by
						  the Quality Improvement Organization contracted with Arkansas Medicaid.
The following codes cannot be billed on the Same
						  Date of Service:
90849 - Multi-Family Behavioral Health
						  Counseling
90846 - Marital/Family Behavioral Health Counseling
						  without Beneficiary Present
H2027 - Psychoeducation
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
* Providers of dyadic services must be trained and
						  certified in specific evidence based practices to be reimbursed for those
						  services
o Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
o Non-independently Licensed Clinicians -
						  Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
03 (School), 04 (Homeless Shelter), 11 (Office) 12
						  (Patient's Home), 49 (Independent Clinic), 50 (Federally Qualified Health
						  Center), 53 (Community Mental Health Center), 57 (Non-Residential Substance
						  Abuse Treatment Facility), 71 (Public Health Clinic), 72 (Rural Health
						  Clinic)
252.114
Marital/Family Behavioral Health Counseling without Beneficiary
			 Present
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90846, U4
90846, U4, U5 - Substance Abuse
SERVICE DESCRIPTION
Marital/Family Behavioral Health Counseling without
						  Beneficiary Present is a face-to-face treatment provided to one or more family
						  members outside the presence of a beneficiary. Services are designed to enhance
						  insight into family interactions, facilitate inter-family emotional or
						  practical support and to develop alternative strategies to address familial
						  issues, problems and needs. Services pertain to a beneficiary's (a) Mental
						  Health and/or (b) Substance Abuse condition. Additionally, tobacco cessation
						  counseling is a component of this service.
Services must be congruent with the age and abilities
						  of the beneficiary or family member(s), client-centered and strength-based;
						  with emphasis on needs as identified by the beneficiary and family and provided
						  with cultural competence.
Family psychotherapy (without the patient
						  present)
MINIMUM DOCUMENTATION REQUIREMENTS
* Date of Service
* Start and stop times of actual encounter
						  spouse/family
* Place of service
* Participants present and relationship to
						  beneficiary
* Diagnosis and pertinent interval history
* Brief observations with spouse/family
* Rationale for, and description of treatment used that
						  must coincide with the Mental Health Diagnosis and improve the impact the
						  beneficiary's condition has on the spouse/family and/or improve marital/family
						  interactions between the beneficiary and the spouse/family.
* Beneficiary and spouse/family's response to treatment
						  that includes current progress or regression and prognosis
* Any changes indicated for the diagnosis, or
						  medication concerns
* Plan for next session, including any homework
						  assignments and/or crisis plans
* Staff signature/credentials/date of signature
* HIPAA compliant Release of Information, completed,
						  signed and dated
NOTES
UNIT
BENEFIT LIMITS
Natural supports may be included in these sessions if
						  justified in service documentation and if supported in Mental Health Diagnosis.
						  Only one beneficiary per family per therapy session may be billed.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested):
Counseling Level Beneficiaries: 12 encounters
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
A provider can only bill one Marital / Family
						  Behavioral Health Counseling with (or without) Beneficiary encounter per
						  day.
The following codes cannot be billed on the Same
						  Date of Service:
90849 - Multi-Family Behavioral Health
						  Counseling
90847 - Marital/Family Behavioral Health Counseling
						  with Beneficiary Present
H2027 - Psychoeducation
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
03 (School), 04 (Homeless Shelter), 11 (Office) 12
						  (Patient's Home), 49 (Independent Clinic), 50
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
(Federally Qualified Health Center), 53 (Community
						  Mental Health Center), 57 (Non-Residential Substance Abuse Treatment Facility),
						  71 (Public Health Clinic), 72 (Rural Health Clinic)
252.115
Psychoeducation
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
H2027, U4
H2027, U4, GT - Telemedicine
H2027, UK, U4 - Dyadic Treatment
*
Psychoeducational service; per 15 minutes
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Psychoeducation provides beneficiaries and their
						  families with pertinent information regarding mental illness, substance abuse,
						  and tobacco cessation, and teaches problem-solving, communication, and coping
						  skills to support recovery. Psychoeducation can be implemented in two formats:
						  multifamily group and/or single family group. Due to the group format,
						  beneficiaries and their families are also able to benefit from support of peers
						  and mutual aid. Services must be congruent with the age and abilities of the
						  beneficiary, client-centered, and strength-based; with emphasis on needs as
						  identified by the beneficiary and provided with cultural competence.
*Dyadic treatment is available for
						  parent/caregiver & child for dyadic treatment of children age 0 through 47
						  months & parent/caregiver. Dyadic treatment must be prior authorized.
						  Providers must utilize a national recognized evidence based practice. Practices
						  include, but are not limited to, Nurturing Parents and Incredible
						  Years.
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary and spouse/family
* Place of service
* Participants present
* Nature of relationship with beneficiary
* Rationale for excluding the identified
						  beneficiary
* Diagnosis and pertinent interval history
* Rationale for and objective used that must coincide
						  with Mental Health Diagnosis and improve the impact the beneficiary's condition
						  has on the spouse/family and/or improve marital/family interactions between the
						  beneficiary and the spouse/family.
* Spouse/Family response to treatment that includes
						  current progress or regression and prognosis
* Any changes indicated diagnosis, or medication
						  concerns
* Plan for next session, including any homework
						  assignments and/or crisis plans
* HIPAA compliant Release of Information forms,
						  completed, signed and dated
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
Information to support the appropriateness of excluding
						  the identified beneficiary must be documented in the service note and medical
						  record. Natural supports may be included in these sessions when the nature of
						  the relationship with the beneficiary and that support's expected role in
						  attaining treatment goals is documented. Only one beneficiary per family per
						  therapy session may be billed.
15 minutes
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED (extension
						  of benefits can be requested): 48
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
A provider can only bill a total of 48 units of
						  Psychoeducation
The following codes cannot be billed on the Same
						  Date of Service:
90847 - Marital/Family Behavioral Health Counseling
						  with Beneficiary Present
90846 - Marital/Family Behavioral Health Counseling
						  without Beneficiary Present
90847 - Marital/Family Behavioral Health Counseling
						  with Beneficiary Present
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Telemedicine (Adults, Youth, and Children)
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
* Providers of dyadic services must be trained and
						  certified in specific evidence based practices to be reimbursed for those
						  services
o Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
o Non-independently Licensed Clinicians
						  -Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office) 12 (Patient's Home), 49 (Independent Clinic), 50 (Federally
						  Qualified Health Center), 53 (Community Mental Health Center), 57
						  (Non-Residential Substance Abuse Treatment Facility), 71 (Public Health
						  Clinic), 72 (Rural Health Clinic)
252.116
			 Multi-Family Behavioral Health Counseling
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90849, U4
90849, U4, U5 - Substance Abuse
Multiple-family group psychotherapy
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Multi-Family Behavioral Health Counseling is a group
						  therapeutic intervention using face-to-face verbal interaction between two (2)
						  to a maximum of nine (9) beneficiaries and their family members or significant
						  others. Services are a more cost-effective alternative to Marital/Family
						  Behavioral Health Counseling, designed to enhance members' insight into family
						  interactions, facilitate inter-family emotional or practical support and to
						  develop alternative strategies to address familial issues, problems and needs.
						  Services may pertain to a beneficiary's (a) Mental Health or (b) Substance
						  Abuse condition. Additionally, tobacco cessation counseling is a component of
						  this service. Services must be congruent with the age and abilities of the
						  beneficiary, client-centered and strength-based; with emphasis on needs as
						  identified by the beneficiary and family and provided with cultural
						  competence.
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary and/or spouse/family
* Place of service
* Participants present
* Nature of relationship with beneficiary
* Rationale for excluding the identified
						  beneficiary
* Diagnosis and pertinent interval history
* Rationale for and objective used to improve the
						  impact the beneficiary's condition has on the spouse/family and/or improve
						  marital/family interactions between the beneficiary and the
						  spouse/family.
* Spouse/Family response to treatment that includes
						  current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Plan for next session, including any homework
						  assignments and/or crisis plans
* HIPAA compliant Release of Information forms,
						  completed, signed and dated
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
May be provided independently if patient is being
						  treated for substance abuse diagnosis only. Comorbid substance abuse should be
						  provided as integrated treatment utilizing Family Psychotherapy.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested): 12
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
There are 12 total Multi-Family Behavioral Health
						  Counseling encounters allowed per year.
The following codes cannot be billed on the Same
						  Date of Service:
90846 - Marital/Family Behavioral Health Counseling
						  without Beneficiary Present
90847 - Marital/Family Behavioral Health Counseling
						  with Beneficiary Present
90887 - Interpretation of Diagnosis
90887 - Interpretation of Diagnosis,
						  Telemedicine
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING
						  PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
03 (School), 11 (Office), 49 (Independent Clinic), 50
						  (Federally Qualified Health Center), 53 (Community Mental Health Center), 57
						  (Non-Residential Substance Abuse Treatment Facility), 71 (Public Health
						  Clinic), 72 (Rural Health Clinic)
252.117
Mental Health Diagnosis
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90791, U4
90791, U4, GT - Telemedicine
90791, UC, UK, U4 - Dyadic Treatment
*
Psychiatric diagnostic evaluation (with no medical
						  services)
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Mental Health Diagnosis is a clinical service for the
						  purpose of determining the existence, type, nature, and appropriate treatment
						  of a mental illness or related disorder as described in the current allowable
						  DSM. This service may include time spent for obtaining necessary information
						  for diagnostic purposes. The psychodiagnostic process may include, but is not
						  limited to: a psychosocial and medical history, diagnostic findings, and
						  recommendations. This service must include a face-to-face component and will
						  serve as the basis for documentation of modality and issues to be addressed
						  (plan of care). Services must be congruent with the age and abilities of the
						  beneficiary, client-centered and strength-based; with emphasis on needs as
						  identified by the beneficiary and provided with cultural competence.
* Date of Service
* Start and stop times of the face-to-face encounter
						  with the beneficiary and the interpretation time for diagnostic
						  formulation
* Place of service
* Identifying information
* Referral reason
* Presenting problem(s), history of presenting
						  problem(s), including duration, intensity, and response(s) to prior
						  treatment
* Culturally and age-appropriate psychosocial history
						  and assessment
* Mental status/Clinical observations and
						  impressions
* Current functioning plus strengths and needs in
						  specified life domains
* DSM diagnostic impressions
* Treatment recommendations, and prognosis for
						  treatment
* Goals and objectives to be placed in Plan of
						  Care
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
This service may be billed for face-to-face contact as
						  well as for time spent obtaining necessary information for diagnostic purposes;
						  however, this time may NOT be used for development or submission of required
						  paperwork processes
This service can be provided via telemedicine to
						  beneficiaries only ages 21 and above.
*Dyadic treatment is available for
						  parent/caregiver & child for dyadic treatment of children age 0 through 47
						  months & parent/caregiver. A Mental Health Diagnosis will be required for
						  all children through 47 months to receive services. This service includes up to
						  four encounters for children through the age of 47 months and can be provided
						  without a prior authorization. This service must include an assessment
						  of:
o
Presenting symptoms and
						  behaviors;
o
Developmental and medical
						  history;
o
Family psychosocial and medical
						  history;
o
Family functioning, cultural and communication
						  patterns, and current environmental conditions and stressors;
o
Clinical interview with the primary caregiver
						  and observation of the caregiver-infant relationship and interactive
						  patterns;
o
Child's affective, language, cognitive, motor,
						  sensory, self-care, and social functioning.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested): 1
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults Residents of Long Term
						  Care
The following codes cannot be billed on the Same
						  Date of Service:
90792 - Psychiatric Assessment
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face Telemedicine (Adults Only)
Counseling
ALLOWABLE PERFORMING PROVIDER
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
* Providers of dyadic services must be trained and
						  certified in specific evidence based practices to be reimbursed for those
						  services
o Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
o Non-independently Licensed Clinicians -
						  Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office) 12 (Patient's Home), 32 (Nursing Facility), 49 (Independent
						  Clinic), 50 (Federally Qualified Health Center), 53 (Community Mental Health
						  Center), 57 (Non-Residential Substance Abuse Treatment Facility), 71 (Public
						  Health Clinic), 72 (Rural Health Clinic)
252.118
Interpretation of
			 Diagnosis
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90887, U4
90887, U4, GT - Telemedicine
90887, UC, UK, U4 - Dyadic Treatment
Interpretation or explanation of results of
						  psychiatric, other medical examinations and procedures, or other accumulated
						  data to family or other responsible persons, or advising them how to assist
						  patient
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Interpretation of Diagnosis is a direct service
						  provided for the purpose of interpreting the results of psychiatric or other
						  medical exams, procedures, or accumulated data. Services may include diagnostic
						  activities and/or advising the beneficiary and his/ her family. Services
						  pertain to a beneficiary's (a) Mental Health and/or (b) Substance Abuse
						  condition Consent forms may be required for family or significant other
						  involvement. Services must be congruent with the age and abilities of the
						  beneficiary, client-centered and strength-based; with emphasis on needs as
						  identified by the beneficiary and provided with cultural competence.
* Start and stop times of face-to-face encounter with
						  beneficiary and/or parents or guardian
* Date of service
* Place of service
* Participants present and relationship to
						  beneficiary
* Diagnosis
* Rationale for and objective used that must coincide
						  with the Mental Health Diagnosis
* Participant(s) response and feedback
* Recommendation for additional supports including
						  referrals, resources and information
* Staff signature/credentials/date of
						  signature(s)
NOTES
UNIT
BENEFIT LIMITS
For beneficiaries under the age of 18, the time may be
						  spent face-to-face with the beneficiary; the beneficiary and the parent(s) or
						  guardian(s); or alone with the parent(s) or guardian(s). For beneficiaries over
						  the age of 18, the time may be spent face-to-face with the beneficiary and the
						  spouse, legal guardian or significant other.
This service can be provided via telemedicine to
						  beneficiaries ages 18 and above. This service can also be provided via
						  telemedicine to beneficiaries ages 17 and under with documentation of parental
						  or guardian involvement during the service. This documentation must be included
						  in the medical record.
*Dyadic treatment is available for
						  parent/caregiver & child for dyadic treatment of children age 0 through 47
						  months& parent/caregiver. Interpretation of Diagnosis will be required for
						  all children through 47 months to receive services. This service includes up to
						  four encounters for children through the age of 47 months and can be provided
						  without a prior authorization. The Interpretation of Diagnosis is a direct
						  service that includes an interpretation from a broader perspective the history
						  and information collected through the Mental Health Diagnosis. This
						  interpretation identifies and prioritizes the infant's needs, establishes a
						  diagnosis, and helps to determine the care and services to be
						  provided.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested):
Counseling Level Beneficiary: 1
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
The following codes cannot be billed on the Same
						  Date of Service:
H2027 - Psychoeducation
90792 - Psychiatric Assessment
90849 - Multi-Family Behavioral Health
						  Counseling
H0001 - Substance Abuse Assessment
This service can be provided via telemedicine to
						  beneficiaries ages 18 and above. This service can also be provided via
						  telemedicine to beneficiaries ages 17 and under with documentation of parental
						  or guardian involvement during the service. This documentation must be included
						  in the medical record.
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Telemedicine Adults, Youth and Children
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
* Providers of dyadic services must be trained and
						  certified in specific evidence based practices to be reimbursed for those
						  services
o Independently Licensed Clinicians - Parent/Caregiver
						  & Child (Dyadic treatment of Children age 0-47 months &
						  Parent/Caregiver) Provider
o Non-independently Licensed Clinicians -
						  Parent/Caregiver & Child (Dyadic treatment of Children age 0-47 months
						  & Parent/Caregiver) Provider
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office) 12 (Patient's Home), 49 (Independent Clinic), 50 (Federally
						  Qualified Health Center), 53 (Community Mental Health Center), 57
						  (Non-Residential Substance Abuse Treatment Facility), 71 (Public Health
						  Clinic), 72 (Rural Health Clinic)
252.119
Substance Abuse
			 Assessment
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
H0001, U4
Alcohol and/or drug assessment
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Substance Abuse Assessment is a service that identifies
						  and evaluates the nature and extent of a beneficiary's substance abuse
						  condition using the Addiction Severity Index (ASI) or an assessment instrument
						  approved by DAABHS and DMS. The assessment must screen for and identify any
						  existing co-morbid conditions. The assessment should assign a diagnostic
						  impression to the beneficiary, resulting in a treatment recommendation and
						  referral appropriate to effectively treat the condition(s) identified.
Services must be congruent with the age and abilities
						  of the beneficiary, client-centered and strength-based; with emphasis on needs
						  as identified by the beneficiary and provided with cultural competence.
* Date of Service
* Start and stop times of the face-to-face encounter
						  with the beneficiary and the interpretation time for diagnostic
						  formulation
* Place of service
* Identifying information
* Referral reason
* Presenting problem(s), history of presenting
						  problem(s), including duration, intensity, and response(s) to prior
						  treatment
* Culturally and age-appropriate psychosocial history
						  and assessment
* Mental status/Clinical observations and
						  impressions
* Current functioning and strengths in specified life
						  domains
* DSM diagnostic impressions
* Treatment recommendations and prognosis for
						  treatment
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
The assessment process results in the assignment of a
						  diagnostic impression, beneficiary recommendation for treatment regimen
						  appropriate to the condition and situation presented by the beneficiary,
						  initial plan (provisional) of care and referral to a service appropriate to
						  effectively treat the condition(s) identified. If indicated, the assessment
						  process must refer the beneficiary for a psychiatric consultation
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested): 1
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
The following codes cannot be billed on the Same
						  Date of Service:
90887 - Interpretation of Diagnosis
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral
* Advanced Practice Nurse
* Physician
03 (School), 04 (Homeless Shelter), 11 (Office) 12
						  (Patient's Home), 49 (Independent Clinic), 50 (Federally Qualified Health
						  Center), 53 (Community Mental Health Center), 57 (Non-Residential Substance
						  Abuse Treatment Facility), 71 (Public Health Clinic), 72 (Rural Health
						  Clinic)
252.120
Psychological Evaluation
			 1-1-19
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
96101, U4
Psychological testing (includes psychodiagnostic
						  assessment of emotionality, intellectual abilities, personality and
						  psychopathology, e.g. MMPI, Rorschach®, WAIS®), per hour of the
						  psychologist's or physician's time, both face-toface time administering tests
						  to the patient and time interpret
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION
						  REQUIREMENTS
Psychological Evaluation for personality assessment
						  includes psychodiagnostic assessment of a beneficiary's emotional, personality,
						  and psychopathology, e.g., MMPI, Rorschach®, and WAIS®. Psychological
						  testing is billed per hour both face-time administering tests and time
						  interpreting these tests and preparing the report. This service may reflect the
						  mental abilities, aptitudes, interests, attitudes, motivation, emotional and
						  personality characteristics of the beneficiary.
Services must be congruent with the age and abilities
						  of the beneficiary, client-centered and strength-based; with emphasis on needs
						  as identified by the beneficiary and provided with cultural competence
Medical necessity for this service is met when:
* the service is necessary to establish a differential
						  diagnosis of behavioral or psychiatric conditions
* history and symptomatology are not readily
						  attributable to a particular psychiatric diagnosis
* questions to be answered by the evaluation could not
						  be resolved by a Mental Health Diagnosis or Psychiatric Assessment, observation
						  in therapy, or an assessment for level of care at a mental health
						  facility
* the service provides information relevant to the
						  beneficiary's continuation in treatment and assists in the treatment
						  process
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary
* Start and stop times of scoring, interpretation and
						  report preparation
* Place of service
* Identifying information
* Rationale for referral
* Presenting problem(s)
* Culturally and age-appropriate psychosocial history
						  and assessment
* Mental status/Clinical observations and
						  impressions
* Psychological tests used, results, and
						  interpretations, as indicated
* DSM diagnostic
* Treatment recommendations and findings related to
						  rationale for service and guided by test results
* Staff signature/credentials/date of
						  signature(s)
NOTES
UNIT
BENEFIT LIMITS
This code may not be billed for the completion of
						  testing that is considered primarily educational or utilized for employment,
						  disability qualification, or legal or court related purposes.
60 minutes
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED (extension
						  of benefits can be requested): 8
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Licensed Psychologist (LP)
* Licensed Psychological Examiner (LPE)
* Licensed Psychological Examiner - Independent
						  (LPEI)
03 (School), 11 (Office), 49 (Independent Clinic), 50
						  (Federally Qualified Health Center), 53 (Community Mental Health Center), 57 (
						  Non-Residential Substance Abuse Treatment Facility), 71 (Public Health Clinic),
						  72 (Rural Health Clinic)
252.121
Pharmacologic Management
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
99212, UB, U4 - Physician
99213, UB, U4 - Physician
99214, UB, U4 - Physician
99212, UB, U4, GT - Physician, Telemedicine
99213, UB, U4, GT - Physician, Telemedicine
99214, UB, U4, GT - Physician, Telemedicine
99212, SA, U4 - APN
99213, SA, U4 - APN
99214, SA, U4 - APN
99212, SA, U4, GT- APN, Telemedicine
99213, SA, U4, GT - APN, Telemedicine
99214, SA, U4, GT - APN, Telemedicine
99212: Office or other outpatient encounter for the
						  evaluation and management of an established patient, which requires at least 2
						  of these 3 key components: A problem focused history; A problem focused
						  examination; Straightforward medical decision making
99213: Office or other outpatient encounter for the
						  evaluation and management of an established patient, which requires at least 2
						  of these 3 key components: An expanded problem focused history; An expanded
						  problem focused examination; Medical decision making of low complexity.
99214: Office or other outpatient encounter for the
						  evaluation and management of an established patient, which requires at least 2
						  of these 3 key components: A detailed history, A detailed examination; Medical
						  decision making of moderate complexity
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Pharmacologic Management is a service tailored to
						  reduce, stabilize or eliminate psychiatric symptoms with the goal of improving
						  functioning, including management and reduction of symptoms. This service
						  includes evaluation of the medication prescription, administration, monitoring,
						  and supervision and informing beneficiaries regarding medication(s) and its
						  potential effects and side effects in order to make informed decisions
						  regarding the prescribed medications. Services must be congruent with the age,
						  strengths, and accommodations necessary for disability and cultural
						  framework.
Services must be congruent with the age and abilities
						  of the beneficiary, client-centered and strength-based; with emphasis on needs
						  as identified by the beneficiary and provided with cultural competence.
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary
* Place of service (When 99 is used for telemedicine,
						  specific locations of the beneficiary and the physician must be
						  included)
* Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and treatment used that must coincide
						  with the Psychiatric Assessment
* Beneficiary's response to treatment that includes
						  current progress or regression and prognosis
* Revisions indicated for the diagnosis, or
						  medication(s)
* Plan for follow-up services, including any crisis
						  plans
* If provided by physician that is not a psychiatrist,
						  then any off label uses of medications should include documented consult with
						  the overseeing psychiatrist within 24 hours of the prescription being
						  written
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
Applies only to medications prescribed to address
						  targeted symptoms as identified in the Psychiatric Assessment.
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested): 12
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Telemedicine (Adults, Youth, and Children)
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Advanced Practice Nurse
* Physician
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office), 12 (Patient's Home), 49 (Independent Clinic), 50 (Federally
						  Qualified Health Center), 53 (Community Mental Health Center), 57
						  (Non-Residential Substance Abuse Treatment Facility), 71 (Public Health
						  Clinic), 72 (Rural Health Clinic)
252.122
Psychiatric Assessment
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
90792, U4
90792, U4, GT - Telemedicine
Psychiatric diagnostic evaluation with medical
						  services
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Psychiatric Assessment is a face-to-face
						  psychodiagnostic assessment conducted by a licensed physician or Advanced
						  Practice Nurse (APN), preferably one with specialized training and experience
						  in psychiatry (child and adolescent psychiatry for beneficiaries under age 18).
						  This service is provided to determine the existence, type, nature, and most
						  appropriate treatment of a behavioral health disorder. This service is not
						  required for beneficiaries to receive Counseling Level Services.
* Date of Service
* Start and stop times of the face-to-face encounter
						  with the beneficiary and the interpretation time for diagnostic
						  formulation
* Place of service
* Identifying information
* Referral reason
* The interview should obtain or verify all of the
						  following:
1. The beneficiary's understanding of the factors
						  leading to the referral
2. The presenting problem (including symptoms and
						  functional impairments)
3. Relevant life circumstances and psychological
						  factors
4. History of problems
5. Treatment history
6. Response to prior treatment interventions
7. Medical history (and examination as
						  indicated)
* For beneficiaries under the age of 18
1. an interview of a parent (preferably both), the
						  guardian (including the responsible DCFS caseworker) and/or the primary
						  caretaker (including foster parents) in order to:
a) Clarify the reason for the referral
b) Clarify the nature of the current symptoms
c) Obtain a detailed medical, family and developmental
						  history
* Culturally and age-appropriate psychosocial history
						  and assessment
* Mental status/Clinical observations and
						  impressions
* Current functioning and strengths in specified life
						  domains
* DSM diagnostic impressions
* Treatment recommendations
* Staff signature/credentials/date of signature
NOTES
UNIT
BENEFIT LIMITS
This service may be billed for face-to-face contact as
						  well as for time spent obtaining necessary information for diagnostic purposes;
						  however, this time may NOT be used for development or submission of required
						  paperwork processes (i.e. treatment plans, etc.).
Encounter
DAILY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF ENCOUNTERS THAT MAY BE BILLED
						  (extension of benefits can be requested): 1
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults Telemedicine (Adults,
						  Youth, and Children)
The following codes cannot be billed on the Same
						  Date of Service:
90791 - Mental Health Diagnosis
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Counseling
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
A. an Arkansas-licensed physician, preferably one with
						  specialized training and experience in psychiatry (child and adolescent
						  psychiatry for beneficiaries under age 18)
B. an Adult Psychiatric Mental Health Advanced Nurse
						  Practitioner/Family Psychiatric Mental Health Advanced Nurse Practitioner
						  (PMHNP-BC)
The PMHNP-BC must meet all of the following
						  requirements:
A. Licensed by the Arkansas State Board of
						  Nursing
B. Practicing with licensure through the American
						  Nurses Credentialing Center
C. Practicing under the supervision of an
						  Arkansas-licensed psychiatrist with whom the PMHNP-BC has a collaborative
						  agreement. The findings of the Psychiatric Assessment conducted by the PMHNP-BC
						  must be discussed with the supervising psychiatrist within 45 days of the
						  beneficiary entering care. The collaborative agreement must comply with all
						  Board of Nursing requirements and must spell out, in detail, what the nurse is
						  authorized to do and what age group they may treat.
D. Practicing within the scope of practice as defined
						  by the Arkansas Nurse Practice Act
E. Practicing within a PMHNP-BC's experience and
						  competency level
02 (Telemedicine), 03 (School), 04 (Homeless Shelter),
						  11 (Office), 12, (Patient's Home), 49 (Independent Clinic), 50 (Federally
						  Qualified Health Center), 53 (Community Mental Health Center), 57
						  (Non-Residential Substance Abuse Treatment Facility), 71 (Public Health
						  Clinic), 72 (Rural Health Clinic)
255.001
Crisis Intervention
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
H2011, HA, U4
Crisis intervention service, per 15 minutes
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Crisis Intervention is unscheduled, immediate,
						  short-term treatment activities provided to a Medicaid-eligible beneficiary who
						  is experiencing a psychiatric or behavioral crisis. Services are to be
						  congruent with the age, strengths, needed accommodation for any disability, and
						  cultural framework of the beneficiary and his/her family. These services are
						  designed to stabilize the person in crisis, prevent further deterioration and
						  provide immediate indicated treatment in the least restrictive setting. (These
						  activities include evaluating a Medicaid-eligible beneficiary to determine if
						  the need for crisis services is present.)
Services are to be congruent with the age, strengths,
						  needed accommodation for any disability, and cultural framework of the
						  beneficiary and his/her family.
* Date of service
* Start and stop time of actual encounter with
						  beneficiary and possible collateral contacts with caregivers or informed
						  persons
* Place of service
* Specific persons providing pertinent information in
						  relationship to beneficiary
* Diagnosis and synopsis of events leading up to crisis
						  situation
* Brief mental status and observations
* Utilization of previously established psychiatric
						  advance directive or crisis plan as pertinent to current situation OR rationale
						  for crisis intervention activities utilized
* Beneficiary's response to the intervention that
						  includes current progress or regression and prognosis
* Clear resolution of the current crisis and/or plans
						  for further services
* Development of a clearly defined crisis plan or
						  revision to existing plan
* Staff signature/credentials/date of
						  signature(s)
NOTES
UNIT
BENEFIT LIMITS
A psychiatric or behavioral crisis is defined as an
						  acute situation in which an individual is experiencing a serious mental illness
						  or emotional disturbance to the point that the beneficiary or others are at
						  risk for imminent harm or in which to prevent significant deterioration of the
						  beneficiary's functioning.
This service can be provided to beneficiaries that have
						  not been previously assessed or have not previously received behavioral health
						  services.
The provider of this service MUST complete a Mental
						  Health Diagnosis (90791) within 7 days of provision of this service if provided
						  to a beneficiary who is not currently a client. If the beneficiary cannot be
						  contacted or does not return for a Mental Health Diagnosis appointment,
						  attempts to contact the beneficiary must be placed in the beneficiary's medical
						  record. If the beneficiary needs more time to be stabilized, this must be noted
						  in the beneficiary's medical record and the Division of Medical Services
						  Quality Improvement Organization (QIO) must be notified.
15 minutes
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED (extension
						  of benefits can be requested): 72
APPLICABLE POPULATIONS
SPECIAL BILLING INSTRUCTIONS
Children, Youth, and Adults
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
Crisis
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
* Independently Licensed Clinicians -
						  Master's/Doctoral
* Non-independently Licensed Clinicians -
						  Master's/Doctoral (must be employed by Behavioral Health Agency)
* Advanced Practice Nurse
* Physician (must be employed by Behavioral Health
						  Agency)
03 (School), 04 (Homeless Shelter), 11 (Office) 12
						  (Patient's Home), 15 (Mobile Unit), 23 (Emergency Room), 33 (Custodial Care
						  facility), 49 (Independent Clinic), 50 (Federally Qualified Health Center), 53
						  (Community Mental Health Center), 57( Non-Residential Substance Abuse Treatment
						  Facility), 71 (Public Health Clinic), 72 (Rural Health Clinic), 99 (Other
						  Location)
255.003
Acute Crisis Units
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
H0018, U4
Behavioral Health; short-term residential
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Acute Crisis Units provide brief (96 hours or less)
						  crisis treatment services to persons over the age of 18 who are experiencing a
						  psychiatry- and/or substance abuse-related crisis and may pose an escalated
						  risk of harm to self or others. Acute Crisis Units provide hospital diversion
						  and step-down services in a safe environment with psychiatry and/or substance
						  abuse services on-site at all times as well as on-call psychiatry available 24
						  hours a day. Services provide ongoing assessment and observation; crisis
						  intervention; psychiatric, substance, and co-occurring treatment; and initiate
						  referral mechanisms for independent assessment and care planning as
						  needed.
NOTES
EXAMPLE ACTIVITIES
APPLICABLE POPULATIONS
UNIT
BENEFIT LIMITS
Youth and Adults
Per Diem
* 96 hours or less per encounter
* 1 encounter per month
* 6 encounters per SFY
PROGRAM SERVICE CATEGORY
Crisis Services
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
N/A
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
Acute Crisis Units must be certified by the Division of
						  Provider Services and Quality Assurance as an Acute Crisis Unit Provider
255.004
Substance Abuse
			 Detoxification
CPT®/HCPCS PROCEDURE CODE
PROCEDURE CODE DESCRIPTION
H0014, U4
Alcohol and/or drug services; detoxification
SERVICE DESCRIPTION
MINIMUM DOCUMENTATION REQUIREMENTS
Substance Abuse Detoxification is a set of
						  interventions aimed at managing acute intoxication and withdrawal from alcohol
						  or other drugs. Services help stabilize beneficiaries by clearing toxins from
						  the beneficiary's body. Services are short-term and may be provided in a crisis
						  unit, inpatient, or outpatient setting, and may include evaluation,
						  observation, medical monitoring, and addiction treatment. Detoxification seeks
						  to minimize the physical harm caused by the abuse of substances and prepares
						  the beneficiary for ongoing treatment.
NOTES
EXAMPLE ACTIVITIES
APPLICABLE POPULATIONS
UNIT
BENEFIT LIMITS
Youth and Adults
N/A
* 1 encounter per month
* 6 encounters per SFY
PROGRAM SERVICE CATEGORY
Crisis Services
ALLOWED MODE(S) OF DELIVERY
TIER
Face-to-face
N/A
ALLOWABLE PERFORMING PROVIDERS
PLACE OF SERVICE
Substance Abuse Detoxification must be provided in a
						  facility that is certified by the Division of Provider Services and Quality
						  Assurance as a Substance Abuse Detoxification provider.
21 (Inpatient Hospital), 55 (Residential Substance
						  Abuse Treatment Facility)
256.400
Place of Service Codes
Electronic and paper claims now require the same national place
				of service codes.
Place of Service
POS Codes
Telemedicine
02
School (Including Licensed Child Care Facility)
03
Homeless Shelter
04
Office (Outpatient Behavioral Health Provider Facility
						  Service Site)
11
Patient's Home
12
Group Home
14
Mobile Unit
15
Temporary Lodging
16
Inpatient Hospital
21
Nursing Facility
32
Custodial Care Facility
33
Independent Clinic
49
Federally Qualified Health Center
50
Inpatient Psychiatric Facility
51
Community Mental Health Center
53
Residential Substance Abuse Treatment Facility
55
Non-Residential Substance Abuse Treatment
						  Facility
57
Public Health Clinic
71
Rural Health Clinic
72
Other
99
Behavioral Health Agency Certification
				Manual
I.
PURPOSE:
A. To assure that Outpatient Behavioral
			 Health Services ("OBHS") care and services provided by certified Behavioral
			 Health Agencies comply with applicable laws, which require, among other things,
			 that all care reimbursed by the Arkansas Medical Assistance Program
			 ("Medicaid") must be provided efficiently, economically, only when medically
			 necessary, and is of a quality that meets professionally recognized standards
			 of health care.
B. The requirements
			 and obligations imposed by §§ l-XIII of this rule are substantive,
			 not procedural.
II.
SCOPE:
A. Current Behavioral
			 Health Agency certification under this policy is a condition of Medicaid
			 provider enrollment.
B. Department
			 of Human Services ("DHS") Behavioral Health Agency certification must be
			 obtained for each site before application for Medicaid provider enrollment. An
			 applicant may submit one application for multiple sites, but DHS will review
			 each site separately and take separate certification action for each
			 site.
C. This certification policy
			 applies only to providers in the provision of services in the AR Medicaid fee
			 for service program.
III.
DEFINITIONS:
A. "50 mile radius" means 50 miles from a
			 certified site by driving distance. Driving distance is calculated by a method
			 of utilizing a standardized mapping application.
B. "Accreditation" means full accreditation
			 (preliminary, expedited, probationary, pending, conditional, deferred or
			 provisional accreditations will not be accepted) as an outpatient behavioral
			 health care provider issued by at least one of the following:
* Commission on Accreditation for Rehabilitative Facilities
				(CARF) Behavioral Health Standards Manual
* The Joint Commission (TJC) Comprehensive Accreditation Manual
				for Behavioral Health Care
* Council on Accreditation (COA) Outpatient Mental Health
				Services Manual
Accreditation timing for specific programs is defined in the
				applicable DHS Certification manual for that program.
C. "Adverse license action" means any action
			 by a licensing authority that is related to client care, any act or omission
			 warranting exclusion under DHS Policy 1088, or that imposes any restriction on
			 the licensee's practice privileges. The action is deemed to exist when the
			 licensing entity imposes the adverse action except as provided in Ark. Code
			 Ann. §
											25-15-211(c).
D. "Applicant" means an outpatient behavioral
			 health care agency that is seething DHS - certification as a Behavioral Health
			 Agency. ---------
E.
			 "Certification" means a written designation, issued by DHS, declaring that the
			 provider has demonstrated compliance as declared within and defined by this
			 rule.
F. "Client" means any person
			 for whom a Behavioral Health Agency furnishes, or has agreed or undertaken to
			 furnish, Outpatient Behavioral Health services.
G. "Client Information System" means a
			 comprehensive, integrated system of clinical, administrative, and financial
			 records that provides information necessary and useful to deliver client
			 services. Information may be maintained electronically, in hard copy, or both.
H. "Compliance" means conformance
			 with:
1. Applicable state and federal laws,
			 rules, and regulations including, without limitation:
a. Titles XIX and XXI of the Social Security
			 Act and implementing regulations;
b. Other federal laws and regulations
			 governing the delivery of health care funded in whole or in part by federal
			 funds, for example, 42
			 U.S.C. §
														1320c-5;
c. All state laws and rules applicable to
			 Medicaid generally and to Outpatient Behavioral Health services
			 specifically;
d. Title VI of the
			 Civil Rights Act of 1964 as amended, and implementing regulations;
e. The Americans With Disabilities Act, as
			 amended, and implementing regulations;
f. The Health Insurance Portability and
			 Accountability Act ("HIPAA"), as amended and implementing
			 regulations.
2.
			 Accreditation standards and requirements.
I. "Contemporaneous" means by the end of the
			 performing provider's first work period following the provision of care of
			 services to be documented, or as provided in the Outpatient Behavioral Health
			 Services manual, whichever is longer.
J. "Coordinated Management Plan" means a plan
			 that the provider develops and carries out to assure compliance and quality
			 improvement.
K. "Corrective Action
			 Plan" (CAP) means a document that describes both short- term remedial steps to
			 achieve compliance and permanent practices and procedures to sustain
			 compliance.
L. "Covered Health Care
			 Practitioner" means: Any practitioner providing Outpatient Behavioral Health
			 Services that is allowable to be reimbursed pursuant to the Outpatient
			 Behavioral Health Services Medicaid Manual.
M. "Cultural Competency" means the ability to
			 communicate and interact effectively with people of different cultures,
			 including people with disabilities and atypical lifestyles. N. "Deficiency"
			 means an item or area of noncompliance.
O. "DHS" means the Arkansas Department of
			 Human Services.
P. "Emergency
			 Behavioral Health Agency services" means nonscheduled Behavioral Health Agency
			 services delivered under circumstances where a prudent layperson with an
			 average knowledge of behavioral health care would reasonably believe that
			 Behavioral Health Agency services are immediately necessary to prevent death or
			 serious impairment of health.
Q.
			 "Medical Director" means a physician that oversees the planning and delivery of
			 all Behavioral Health Agency services delivered by the provider.
R. "Mental health professional" or "MHP"
			 means a person who possesses an Arkansas license to provide clinical behavioral
			 health care. The license must be in good standing and not subject to any
			 adverse license action.
S. "Mobile
			 care" means a face-to-face intervention with the client at a place other than a
			 certified site operated by the provider. Mobile care must be:
1. Either clinically indicated in an emergent
			 situation or necessary for the client to have access to care in accordance with
			 the care plan;
2. Delivered in a
			 clinically appropriate setting; and
3. Delivered where Medicaid billing is
			 permitted if delivered to a Medicaid eligible client.
Mobile care may include medically necessary behavioral health
				care provided in a school that is within a fifty (50) mile radius of a
				certified site operated by the provider.
T. "Multi-disciplinary team" means a group of
			 professionals from different disciplines that provide comprehensive care
			 through individual expertise and in consultation with one another to accomplish
			 the client's clinical goals. Multi- disciplinary teams promote coordination
			 between agencies; provide a "checks and balances" mechanism to ensure that the
			 interests and rights of all concerned parties are addressed; and identify
			 service gaps and breakdowns in coordination or communication between agencies
			 or individuals.
U. "NPDB" means the
			 United States Department of Health and Human Services. Health Resources and
			 Services Administration National Provider Data Bank.
V. "Performing provider" means the individual
			 who personally delivers a care or service directly to a client.
W. "Professionally recognized standard of
			 care" means that degree of skill and learning commonly applied under all the
			 circumstances in the community by the average prudent reputable member of the
			 profession. Conformity with Substance Abuse and Mental Health Services
			 Administration (SAMHSA) evidence-based practice models is evidence of
			 compliance with professionally recognized standards of care.
X. "Provider" means an entity that is
			 certified by DHS and enrolled by DMS as a Behavioral Health Agency
Y. "Qualified Behavioral Health Provider"
			 means a person who:--------------------------
1. Does not possess an Arkansas license to
			 provide clinical behavioral health care;
2. Works under the direct supervision of a
			 mental health professional;
3. Has
			 successfully completed prescribed and documented courses of initial and annual
			 training sufficient to perform all tasks assigned by a mental health
			 professional;
4. Acknowledges in
			 writing that all qualified behavioral health provider services are controlled
			 by client care plans and provided under the direct supervision of a mental
			 health professional.
Z.
			 "Quality assurance (QA) meeting" means a meeting held at least quarterly for
			 systematic monitoring and evaluation of clinic services and compliance. See
			 also, Medicaid Outpatient Behavioral Health Services Manual, §
			 212.000.
AA. "Reviewer" means a
			 person employed or engaged by:
1. DHS or a
			 division or office thereof;
2. An
			 entity that contracts with DHS or a division or office thereof.
BB. "Site" means a distinct place
			 of business dedicated to the delivery of Outpatient Behavioral Health Services
			 within a fifty (50) mile radius. Each site must be a bona fide Behavioral
			 Health Agency, meaning a behavioral health outpatient clinic providing all the
			 services specified in this rule and the Medicaid Outpatient Behavioral Health
			 Services Manual. Sites may not be adjuncts to a different activity such as a
			 school, a day care facility, a long-term care facility, or the office or clinic
			 of a physician or psychologist.
CC. "Site relocation" means closing an
			 existing site and opening a new site no more than a fifty (50) mile radius from
			 the original site.
DD. "Site
			 transfer" means moving existing staff, program, and clients from one physical
			 location to a second location that is no more than a fifty (50) mile radius
			 from the original site.
EE.
			 "Supervise" as used in this rule means to direct, inspect, observe, and
			 evaluate performance.
FF.
			 "Supervision documentation" means written records of the time, date,
			 subject(s). and duration of supervisory contact maintained in the provider's
			 official records.
IV.
COMPLIANCE TIMELINE:
A. Entities
			 currently certified as Rehabilitative Services for Persons with Mental Illness
			 (RSPMI) providers will be grandfathered in as certified Behavioral Health
			 Agencies. Current RSPMI agency recertification procedures are based upon
			 national accreditation timelines. Behavioral Health Agency recertification will
			 also be based upon national accreditation timelines.
B. All entities in operation as of the
			 effective date of this rule must comply with this rule within forty-five (45)
			 calendar days in order to maintain certification.
C. DHS may authorize temporary compliance
			 exceptions for new accreditation standards that require independent site
			 surveys and specific service subset accreditations. Such compliance exceptions
			 expire at the end of the provider's accreditation cycle and may not be renewed
			 or reauthorized.
V.
APPLICATION FOR DHS BEHAVIORAL HEALTH AGENCY CERTIFICATION:
A. New Behavioral Health Agency applicants
			 must complete DHS BEHAVIORAL HEALTH AGENCY CERTIFICATION Form 100. DHS
			 BEHAVIORAL HEALTH AGENCY FORM 200. and DHS BEHAVIORAL HEALTH AGENCY Form
			 210
B. DHS BEHAVIORAL HEALTH AGENCY
			 CERTIFICATION Form 100, DHS BEHAVIORAL HEALTH AGENCY FORM 200. and DHS
			 BEHAVIORAL HEALTH AGENCY Form 210 can be found at the following website:
www.arkansas.gov/dhs/dhs
C. Applicants must submit the completed
			 application forms and all required attachments for each proposed site to:
Department of Human Services
Division of Behavioral Health Services
Attn. Certification Office
305 S. Palm
Little Rock, AR 72205
D. Each applicant must be an outpatient
			 behavioral health care agency:
1. Whose
			 primary purpose is the delivery of a continuum of outpatient behavioral health
			 services in a free standing independent clinic;
2. That is independent of any DHS certified
			 Behavioral Health Agency.
E. Behavioral Health Agency certification is
			 not transferable or assignable.
F.
			 The privileges of a Behavioral Health Agency certification are limited to the
			 certified site.
G. Providers may
			 file Medicaid claims only for Outpatient Behavioral Health Services delivered
			 by a performing provider engaged by the provider.
H. Applications must be made in the name used
			 to Identify the business entity to the Secretary of State and for tax
			 purposes.
I. Applicants must
			 maintain and document accreditation, and must prominently display certification
			 of accreditation issued by the accrediting organization in a public area at
			 each site. Accreditation must recognize and Include all the applicant's
			 Behavioral Health Agency programs, services, and sites.
1. Initial accreditation must Include an
			 on-site survey for each service site for which provider certification is
			 requested. Accreditation documentation submitted to DHS must list all sites
			 recognized and approved by the accrediting organization as the applicant's
			 service sites.
2. Accreditation
			 documentation must Include the applicant's governance standards for operation
			 and sufficiently define and describe all services or types of care (customer
			 service units or service standards) the applicant intends to provide including,
			 without limitation, crisis intervention/stabilization, in-home family
			 counseling, outpatient treatment, day treatment, therapeutic foster care,
			 intensive outpatient, medication management/pharmacotherapy.
3. Any outpatient behavioral health program
			 associated with a hospital must have a free-standing behavioral health
			 outpatient program national accreditation.
J. The applicant must attach the entity's
			 family involvement policy to each application.
VI.
APPLICATION REVIEW PROCESS:
A. Timeline:
1. DHS will review Behavioral Health Agency
			 application forms and materials within ninety (90) calendar days after DHS
			 receives a complete application package. (DHS will return incomplete
			 applications to senders without review.)
2. For approved applications, a site survey
			 will be scheduled within forty-five (45) calendar days of the approval
			 date.
3. DHS will mail a survey
			 report to the applicant within twenty-five (25) calendar days of the site
			 visit. Providers having deficiencies on survey reports must submit an
			 approvable corrective action plan to DHS within thirty-five (35) calendar days
			 after the date of a survey report.
4. DHS will accept or reject each corrective
			 action plan in writing within twenty (20) calendar days after
			 receipt.
5. Within thirty (30)
			 calendar days after DHS approves a corrective action plan, the applicant must
			 document implementation of the plan and correction of the deficiencies listed
			 in the survey report. Applicants who are unable, despite the exercise of
			 reasonable diligence, to correct deficiencies within the time permitted may
			 obtain up to ten (10) additional days based on a showing of good
			 cause.
6. DHS will furnish
			 site-specific certificates via postal or electronic mail within ten (10)
			 calendar days of issuing a site certification.
B. Survey Components: An outline of site
			 survey components is available on the DHS website:
www.arkansas.gov/dhs/dhs
and is
			 located in appendix # 7.
C.
			 Determinations:
1. Application
			 approved.
2. Application returned
			 for additional information.
3.
			 Application denied. DHS will state the reasons for denial in a written response
			 to the applicant.
VII.
DHS Access to
			 Applicants/Providers:
A. DHS may
			 contact applicants and providers at any time;
B. DHS may make unannounced visits to
			 applicants/providers.
C.
			 Applicants/providers shall provide DHS prompt direct access to
			 applicant/provider documents and to applicant/provider staff and contractors,
			 including, without limitation, clinicians, paraprofessionals, physicians,
			 administrative, and support staff.
D. DHS reserves the right to ask any
			 questions or request any additional information related to certification,
			 accreditation, or both.
VllI.
ADDITIONAL CERTIFICATION
			 REQUIREMENTS:
A. Care and Services
			 must:
1. Comply with all state and federal
			 laws, rules, and regulations applicable to the furnishing of health care funded
			 in whole or in part by federal funds; to all state laws and policies applicable
			 to Arkansas Medicaid generally, and to Outpatient Behavioral Health Services
			 specifically, and to all applicable Department of Human Services ("DHS")
			 policies including, without limitation, DHS Participant Exclusion Policy §
			 1088.0.0. The Participant Exclusion Policy is available online at
			 https://dhsshare.arkansas.gov/DHS%20Policies/Forms/By%20Policy.aspx
2. Conform to professionally recognized
			 behavioral health rehabilitative treatment models.
3. Be established by contemporaneous
			 documentation that is accurate and demonstrates compliance. Documentation will
			 be deemed to be contemporaneous if recorded by the end of the performing
			 provider's first work period following the provision of the care or services to
			 be documented, or as provided in the Outpatient Behavioral Health Services
			 manual, § 252.110, whichever is longer.
B. Applicants and Behavioral Health Agencies
			 must:
1. Be a legal entity in good
			 standing;
2. Maintain all required
			 business licenses;
3. Adopt a
			 mission statement to establish goals and guide activities;
4. Maintain a current organizational chart
			 that identifies administrative and clinical chains of command.
C. Applicants/providers must
			 establish and comply with operating policy that at a minimum implements
			 credible practices and standards for:
1.
			 Compliance;
2. Cultural
			 competence;
3. Provision of
			 services, including referral services, for clients that are indigent, have no
			 source of third party payment, or both, including:
a. Procedures to follow when a client is
			 rejected for lack of a third-party payment source or when a client Is
			 discharged for nonpayment of care.
b. Coordinated referral plans for clients
			 that the provider lacks the capacity to provide medically necessary Outpatient
			 Behavioral Health Services. Coordinated referral plans must:
i. Identify in the client record the
			 medically necessary Outpatient Behavioral Health Services that the provider
			 cannot or will not furnish;
ii.
			 State the reason(s) in the client record that the provider cannot or will not
			 furnish the care;
iii. Provide
			 quality-control processes that assure compliance with care, discharge, and
			 transition plans.
IX.
STAFFING REQUIREMENTS FOR
			 CERTIFICATION
A. At a minimum,
			 Behavioral Health Agency staffing shall be sufficient to establish and
			 implement services for each Behavioral Health Agency client, and must include
			 the following:
1.
Chief Executive
			 Officer/Executive Director (or functional equivalent) (full-time position or
			 full-time equivalent positions):
The person or persons identified to
			 carry out CEO/ED functions:
a. Is/are
			 ultimately responsible for applicant/provider organization, staffing, policies
			 and practices, and Behavioral Health Agency service delivery;
b. Must possess a master's degree in
			 behavioral health care, management, or a related field and experience, and meet
			 any additional qualifications required by the provider's governing body. Other
			 job- related education, experience, or both, may be substituted for all or part
			 of these requirements upon approval of the provider's governing body.
2.
Clinical Director (or
			 functional equivalent) (full-time position or full-time equivalent positions):
The person or persons identified to carry out clinical director
			 functions must:
a. Report directly to the
			 CEO/ED;
b. Be the DHS contact for
			 clinical and practice-related issues;
c. Be accountable for all clinical services
			 (professional and paraprofessional);
d. Be responsible for Behavioral Health
			 Agency care and service quality and compliance;
e. Assure that all services are provided
			 within each practitioner's scope of practice under Arkansas law and under such
			 supervision as required by law for practitioners not licensed to practice
			 independently;
f. Assure and
			 document in the provider's official records the direct supervision of MHP's,
			 either personally or through a documented chain of supervision.
g. Assure that licensed mental health
			 professionals directly supervise Qualified Behavioral Health Providers. Direct
			 supervision ratios must not exceed one licensed mental health professional to
			 ten (10) Qualified Behavioral Health Providers;
h. Possess independent Behavioral Health
			 licensure in Arkansas as a Licensed Psychologist, Licensed Certified Social
			 Worker, (LCSW), Licensed Psychological Examiner - Independent (LPE-I), Licensed
			 Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), or
			 an Advanced Practice Nurse or Clinical Nurse Specialist (APN or CNS) with a
			 specialty in psychiatry or mental health and a minimum of two years clinical
			 experience post master's degree.
3.
Mental Health Professionals
			 (Independently Licensed Clinicians, Non-Independently Licensed
			 Clinicians):
a. MHP's may:
i. Provide direct behavioral health
			 care;
ii. Delegate and oversee work
			 assignments of Qualified Behavioral Health Provider's;
iii. Delegate and oversee work assignments of
			 Certified Peer Specialists, Certified Youth Support Specialists, and Certified
			 Family Support Partners
iv. Ensure
			 compliance and conformity to the provider's policies and procedures;
v. Provide direct supervision of Qualified
			 Behavioral Health Provider's;
vi.
			 Provider direct supervision of Certified Peer Specialists, Certified Youth
			 Support Specialists, and Certified Family Support Partners
vii. Provide case consultation and in-service
			 training;
viii. Observe and
			 evaluate performance of Qualified Behavioral Health Provider's.
ix. Observe and evaluate performance of
			 Certified Peer Specialists, Certified Youth Support Specialists, and Certified
			 Family Support Partners
b. MHP Supervision:
i.
			 Communication between an MHP and the MHP's supervisor must include each of the
			 following at least every twelve (12) months:
1. Assessment and referral skills, including
			 the accuracy of assessments;
2.
			 Appropriateness of treatment or service interventions in relation to the client
			 needs;
3. Treatment/intervention
			 effectiveness as reflected by the client meeting individual goals;
4. Issues of ethics, legal aspects of
			 clinical practice, and professional standards;
5. The provision of feedback that enhances
			 the skills of direct service personnel;
6. Clinical documentation issues identified
			 through ongoing compliance review;
7. Cultural competency issues;
8. All areas noted as deficient or needing
			 improvement.
ii.
			 Documented client-specific face-to-face and other necessary communication
			 regarding client care must occur between each MHP's supervisor and the MHP
			 periodically (no less than every ninety (90) calendar days) in accordance with
			 a schedule maintained in the provider's official records.
4.
Qualified Behavioral
			 Health Providers (including Certified Peer Support Specialist,):
a. Are MHP service extenders;
b. Qualified Behavioral Health Provider
			 supervision must conform to the requirements for MHP supervision (See § IX
			 (3){b)) except that all requirements must be met every six (6) months, and one
			 or more licensed health care professional(s) acting within the scope of his or
			 her practice must have a face-to-face contact with each Qualified Behavioral
			 Health Provider for the purpose of clinical supervision at least every fourteen
			 (14) days, must have at least twelve (12) such face-to-face contacts every
			 ninety (90) days, and such additional face-to-face contacts as are necessary in
			 response to a client's unscheduled care needs, response or lack of response to
			 treatment, or change of condition;
c. Providers must establish that Qualified
			 Behavioral Health Provider supervision occurred via individualized written
			 certifications created by a licensed mental health professional and filed in
			 the provider's official records on a weekly basis, certifying:
i. That the licensed mental health
			 professional periodically (in accordance with a schedule tailored to the
			 client's condition and care needs and previously recorded in the provider's
			 official records) communicated individualized client-specific instructions to
			 the mental health paraprofessional describing the manner and methods for the
			 delivery of paraprofessional services;
ii. That the licensed mental health
			 professional periodically (in accordance with a schedule tailored to the
			 client's condition and care needs and previously recorded in the provider's
			 official records, but no less than every 30 days) personally observed the
			 mental health paraprofessional delivering services to a client; that the
			 observations were of sufficient duration to declare whether paraprofessional
			 services complied with the licensed mental health professional's
			 instructions;
iii. The date, time,
			 and duration of each supervisory communication with and observation of a
			 Qualified Behavioral Health Provider.
d. The Behavioral Health Agency is
			 responsible for ensuring Qualified Behavioral Health Providers that are not
			 certified as Certified Peer Support Specialists, successfully complete training
			 in behavioral health services provision from a licensed medical person
			 experienced in the area of behavioral health, a certified Behavioral Agency, or
			 a facility licensed by the State Board of Education before providing care to
			 Medicaid beneficiaries.
i. The Qualified
			 Behavioral Health Provider must receive orientation to the Behavioral Health
			 Agency.
ii. The Qualified
			 Behavioral Health Provider training course offered for those individuals not
			 certified as Certified Peer Support Specialist, must total a minimum of forty
			 (40) classroom hours and must be successfully completed within a maximum time
			 of the first two (2) months of employment by the Behavioral Health Agency.
iii. The training curriculum must
			 contain information specific to the population being served, i.e. adult, dually
			 diagnosed, etc. The curriculum must include, but is not limited to:
1. Communication skills.
2. Knowledge of behavioral health
			 illnesses.
3. How to be an
			 appropriate role model.
4. Behavior
			 management.
5. Handling
			 emergencies.
6. Record keeping:
			 observing beneficiary, reporting or recording observations, time, or employment
			 records.
7. Knowledge of clinical
			 limitations.
8. Knowledge of
			 appropriate relationships with beneficiary.
9. Group interaction.
10. Identification of real issues.
11. Listening techniques.
12. Confidentiality.
13. Knowledge of medications and side
			 effects.
14. Daily living
			 skills.
15. Hospitalization
			 procedures single-point-of-entry.
16. Knowledge of the Supplemental Security
			 Income (SSI) application process.
17. Knowledge of day treatment models proper
			 placement levels.
18. Awareness of
			 options.
19. Cultural
			 competency.
20. Ethical issues in
			 practice.
21. Childhood
			 development, if serving the child and adolescent population.
iv. A written examination of the
			 Qualified Behavioral Health Provider's that are not certified as Certified Peer
			 Support Specialists, knowledge of the 40-hour classroom training curriculum
			 must be successfully completed.
v.
			 Evaluation of the Qualified Behavioral Health Provider's ability to perform
			 daily living skills (DLS) for mental health services must be successfully
			 completed by means of a skills test.
vi. The Qualified Behavioral Health Provider
			 who successfully completes the training must be awarded a certificate. This
			 certificate must state the person is qualified to work in an agency under
			 professional supervision as a Qualified Behavioral Health Provider.
vii. In-service training sessions are
			 required at a minimum of once per 12-month period after the successful
			 completion of the initial 40-hour classroom training for Qualified Behavioral
			 Health Specialists not certified as Certified Peer Support Specialist, The
			 in-service training must total a minimum of eight (8) hours each 12-month
			 period beginning with the date of certification as a Qualified Behavioral
			 Health Provider and each 12-month period thereafter.
The in-service training may be conducted, in part, in the
				field. Documentation of in-service hours will be maintained in the employee's
				personnel record and will be available for inspection by regulatory
				agencies.
5.
Corporate Compliance Officer:
a. Manages policy, practice standards and
			 compliance, except compliance that is the responsibility of the medical records
			 librarian;
b. Reports directly to
			 the CEO/ED (except in circumstances where the compliance officer is required to
			 report directly to a director, the board of directors, or an accrediting or
			 oversight agency);
c. Has no direct
			 responsibility for billings or collections;
d. Is the DHS and Medicaid contact for DHS
			 certification, Medicaid enrollment, and compliance.
6.
Medical Director:
a. Oversees Behavioral Health Agency care
			 planning, coordination, and delivery, and specifically:
i. Diagnoses, treats, and prescribes for
			 behavioral illness;
ii. Is
			 responsible and accountable for all client care, care planning, care
			 coordination, and medication storage;
iii. Assures that physician care is available
			 24 hours a day, 7 days a week;
iv.
			 May delegate client care to other physicians, subject to documented oversight
			 and approval;
v. Assures that a
			 physician participates in treatment planning and reviews;
vi. If the medical director is not a
			 psychiatrist, a psychiatrist certified by one of the specialties of the
			 American Board of Medical Specialties must serve as a consultant to the medical
			 director and to other staff, both medical and non-medical. If the provider
			 serves clients under the age of twenty-one (21), the medical director shall
			 have access to a board certified child psychiatrist, for example, through the
			 Psychiatric Research Institute child/Adolescent Telephone Consultation
			 Service;
vii. Medical director
			 services may be acquired by contract.
b. If the medical director is not a
			 psychiatrist then the medical director shall contact a consulting psychiatrist
			 within twenty-four (24) hours in the following situations:
i. When antipsychotic or stimulant
			 medications are used in dosages higher than recommended in guidelines published
			 by the Arkansas Department of Human Services Division of Medical
			 Services;
ii. When two (2) or more
			 medications from the same pharmacological class are used;
iii. When there is significant clinical
			 deterioration or crisis with enhanced risk of danger to self or
			 others.
c. The
			 consulting psychiatrist(s) shall participate in quarterly quality assurance
			 meetings.
7.
Privacy Officer:
Develops and implements policies to assure
			 compliance with privacy laws, regulations, and rules. Applicants/providers may
			 assign privacy responsibilities to the Corporate Compliance Officer, Grievance
			 Officer, or Medical Records Librarian, but not the CEO/ED.
8.
Quality Control Manager:
Chairs the quality assurance committee and develops and implements quality
			 control and quality improvement activities. Applicants/providers may assign
			 quality control manager responsibilities to the Corporate Compliance Officer or
			 Medical Records Manager, but not the CEO/ED.
9.
Grievance Officer:
a. Develops and implements the
			 applicant's/provider's employee and client grievance procedures.
b. Effectively communicates grievance
			 procedures to staff, contractors, prospective clients, and clients.
			 Communications to clients who are legally incapacitated shall include
			 communication to the client's responsible party.
c. The grievance officer shall not have any
			 duties that may cause him/her to favor or disfavor any grievant.
10.
Medical Records
			 Librarian:
a. Must be qualified by
			 education, training, and experience to understand and apply:
i. Medical and behavioral health terminology
			 and usages covering the full range of services offered by the
			 provider;
ii. Medical records forms
			 and formats;
iii. Medical records
			 classification systems and references such as The American Psychiatric
			 Association's Diagnostic and Statistical Manual - IV-TR (DSM-IV-TR) and
			 subsequent editions. International Classification of Diseases (ICD), Diagnostic
			 Related Groups (DRG's), Physician's Desk Reference (PDR), Current Procedural
			 Terminology (CPT), medical dictionaries, manuals, textbooks, and
			 glossaries.
iv. Legal and
			 regulatory requirements of medical records to assure the record is acceptable
			 as a legal document;
v. Laws and
			 regulations on the confidentiality of medical records (Privacy Act and Freedom
			 of Information Act) and the procedures for informed consent for release of
			 information from the record.
vi.
			 The interrelationship of record services with the rest of the facility's
			 services.
b. Develops
			 and implements:
i. The client information
			 system;
ii. Operating methods and
			 procedures covering all medical records functions.
iii. Insures that the medical record is
			 complete, accurate, and compliant.
11.
Licensed Psychologist, Licensed
			 Psychological Examiner (LPE), or Licensed Psychological Examiner - Independent
			 (LPE-I):
a. Provides psychological
			 evaluations;
b. Each licensed
			 psychological examiner or licensed psychological examiner-l must have
			 supervision agreements with a doctoral psychologist to provide appropriate
			 supervision or services for any evaluations or procedures that are required
			 under or are outside the psychological examiner's scope of independent
			 practice. Documentation of such agreements and of all required supervision and
			 other practice arrangements must be included in the psychological examiner's
			 personnel record;
c. Services may
			 be acquired by contract
B. Multidisciplinary Team(s): Any client
			 identified as Tier 2 by the independent assessment shall be assigned a
			 multidisciplinary team that includes professionals and qualified behavioral
			 health providers as necessary to ensure coordination of each client's
			 Outpatient Behavioral Health Services. All Tier 2 clients require the
			 development of a Master Treatment Plan with ongoing reviews at least every
			 one-hundred and eighty (180) calendar days.
For clients not eligible for Rehabilitative (Tier 2) Level or
				Intensive (Tier 3) Level services, he services offered in the Counseling Level
				(Tier 1) are a limited array of counseling services provided by a master's
				level clinician. Establishment of goals and a plan to reach those goals is part
				of good clinical practice and can be developed with the client during the
				Mental Health Diagnostic Assessment and Interpretation of Diagnosis. Clinicians
				should assess client's response to treatment at each session which should
				include a review of progress towards mutually agreed upon goals.
C. Quality Assurance Meetings:
Each provider must hold a quarterly quality assurance
				meeting.
D. Health Care
			 Professional Notification/Disqualification:
1.
			 Notice of covered health care practitioners:
a. Within twenty (20) days of the effective
			 date of this rule, applicants/providers must notify the Office of Medicaid
			 Inspector General (OMIG) of the names of covered health care practitioners who
			 are providing Outpatient Behavioral Health Services.
b. On or before the tenth day of each month,
			 providers must notify the Office of Medicaid Inspector General (OMIG) of the
			 names of all covered health care practitioners who are providing Outpatient
			 Behavioral Health Services and whose names were not previously
			 disclosed.
2. Licensed
			 health care professionals may not furnish Outpatient Behavioral Health Services
			 during any time the professional's license is subject to adverse license
			 action.
3. Applicants/providers may
			 not employ/engage a covered health care practitioner after learning that the
			 practitioner:
a. Is excluded from Medicare,
			 Medicaid, or both;
b. Is debarred
			 under Ark. Code Ann. § 19-11 -245;
c. Is excluded under DHS Policy 1088; or d.
			 Was subject to a final determination that the provider failed to comply with
			 professionally recognized standards of care, conduct, or both. For purposes of
			 this subsection, "final determination" means a final court or administrative
			 adjudication, or the result of an alternative dispute resolution process such
			 as arbitration or mediation.
E. Applicants/providers must maintain
			 documentation identifying the primary work location of all mental health
			 professionals and qualified behavioral health providers providing services on
			 behalf of the Behavioral Health Agency.
F. Providers must maintain copies of
			 disclosure forms signed by the client, or by the client's parent or guardian
			 before Outpatient Behavioral Health Services are delivered except in
			 emergencies. Such forms must at a minimum:
1.
			 Disclose that the services to be provided are Outpatient Behavioral Health
			 Services;
2. Explain Outpatient
			 Behavioral Health Services eligibility, SED and SMI criteria;
3. Contain a brief description of the
			 Behavioral Health Agency services;
4. Explain that all Outpatient Behavioral
			 Health Services care must be medically necessary;
5. Disclose that third party (e.g., Medicaid
			 or insurance) Outpatient Behavioral Health Service payments may be denied based
			 on the third party payer's policies or rules;
6. Identify and define any services to be
			 offered or provided in addition to those offered by the Behavioral Health
			 Agency, state whether there will be a charge for such services, and if so,
			 document payment arrangements;
7.
			 Notify that services may be discontinued by the client at any time;
8. Offer to provide copies of Behavioral
			 Health Agency and Outpatient Behavioral Health Services rules;
9. Provide and explain contact information
			 for making complaints to the provider regarding care delivery, discrimination,
			 or any other dissatisfaction with care provided by the Behavioral Health
			 Agency;
10. Provide and explain
			 contact information for making complaints to state and federal agencies that
			 enforce compliance under § 111(G)(1).
G. Outpatient Behavioral Health Services
			 maintained at each site must include:
1.
			 Psychiatric Evaluation and Medication Management;
2. Outpatient Services, including individual
			 and family therapy at a minimum;
3.
			 Crisis Services.
L.
			 Providers must tailor all Outpatient Behavioral Health Services care to
			 individual client need. If client records contain entries that are materially
			 identical, DHS and the Division of Medical Services will, by rebuttable
			 presumption, that this requirement is not met.
M. Outpatient Behavioral Health Services for
			 individuals under age eighteen (18): Providers must establish and Implement
			 policies for family identification and engagement in treatment for persons
			 under age eighteen (18), including strategies for identifying and overcoming
			 barriers to family involvement.
N.
			 Emergency Response Services: Applicants/providers must establish, implement,
			 and maintain a site-specific emergency response plan, which must include:
1. A 24-hour emergency telephone
			 number;
2. The applicant/provider
			 must:
a. Provide the 24-hour emergency
			 telephone number to all clients;
b.
			 Post the 24-hour emergency number on all public entries to each site;
c. Include the 24-hour emergency phone number
			 on answering machine greetings;
d.
			 Identify local law enforcement and medical facilities within a 50-mile radius
			 that may be emergency responders to client emergencies.
3. Direct access to a mental health
			 professional within fifteen (15) minutes of an emergency/crisis call and
			 face-to-face crisis assessment within two (2) hours;
4. Response strategies based upon:
a. Time and place of occurrence;
b. Individual's status
			 (client/non-client);
c. Contact
			 source (family, law enforcement, health care provider, etc.).
5. Requirements for a face-to-face
			 response to requests for emergency intervention received from a hospital or law
			 enforcement agency regarding a current client.
6. All face-to-face emergency responses shall
			 be:
a. Available 24 hours a day, 7 days a
			 week;
b. Made by a mental health
			 professional within two (2) hours of request (unless a different time frame is
			 within clinical standards guidelines and mutually agreed upon by the requesting
			 party and the MHP responding to the call).
7. Emergency services training requirements
			 to ensure that emergency service are age-appropriate and comply with
			 accreditation requirements. Providers shall maintain documentation of all
			 emergency service training in each trainee's personnel file.
8. Requirements for clinical review by the
			 clinical supervisor or emergency services director within 24 hours of each
			 after-hours emergency intervention with such additional reporting as may be
			 required by the provider's policy.
9. Requirements for documentation of all
			 crisis calls, responses, collaborations, and outcomes;
10. Requirements that emergency responses not
			 vary based on the client's funding source. If a client is eligible for
			 inpatient behavioral health care funded through the community mental health
			 centers and the provider is not a community mental health center with access to
			 these funds, the provider must:
a. Determine
			 whether the safest, least restrictive alternative is psychiatric
			 hospitalization; and
b. Contact the
			 appropriate community mental health center (CMHC) for consult and to request
			 the CMHC to access local acute care funds for those over 21.
O. Each
			 applicant/provider must establish and maintain procedures, competence, and
			 capacity;
1. For assessment and
			 individualized care planning and delivery;
2. For discharge planning integral to
			 treatment;
3. For mobile
			 care;
4. To assure that each mental
			 health professional makes timely clinical disposition decisions;
5. To make timely referrals to other
			 services;
6. To refer for inpatient
			 services or less restrictive alternative;
7. To identify clients who need direct access
			 to clinical staff, and to promptly provide such access.
P. Each applicant/provider must establish,
			 maintain, and document a quality improvement program, to include:
1. Evidence based practices;
2. Use of agency wide outcomes measures to
			 improve both client care and clinical practice that are approved by the
			 agency's national accrediting organization. The following must be documented:
a. Measured outcomes
b. Sample report
c. Collection of outcomes, beginning at the
			 initial mental health diagnosis service, which would be completed very close to
			 the client's intake.
3.
			 Requirements for informing all clients and clients' responsible parties of the
			 client's rights while accessing services.
4. Regular (at least quarterly) quality
			 assurance meetings that include:
a. Clinical
			 Record Reviews: medical record reviews of a minimum number of randomly selected
			 charts. The minimum number is the lesser of a statistically valid sample
			 yielding 95% confidence with a 5% margin of error; or 10% of all charts open at
			 any time during the past three (3) months;
b. Program and services reviews that:
i. Assess and document whether care and
			 services meet client needs;
ii.
			 Identify unmet behavioral health needs;
iii. Establish and implement plans to address
			 unmet needs.
X.
HOME OFFICE:
A. Each provider must maintain and identify a
			 home office in the State of Arkansas;
B. The home office may be located at a site
			 or may be solely an administrative office not requiring site
			 certification;
C. The home office
			 is solely responsible for governance and administration of all of the
			 provider's Arkansas sites;
D. Home
			 office governance and administration must be documented in a coordinated
			 management plan;
E. The home office
			 shall establish policies for maintaining client records, including policies
			 designating where the original records are stored.
XI.
SITE REQUIREMENTS
A. All sites must be located in the State of
			 Arkansas;
B. Accreditation
			 documentation must specifically include each site.
XII.
SITE RELOCATION. OPENING, AND
			 CLOSING
(Note: temporary service disruptions caused by inclement weather
			 or power outages are not "closings.")
A.
			 Planned Closings:
1. Upon deciding to close a
			 site either temporarily or permanently, the provider immediately must provide
			 written notice to clients, DHS, the Division of Medical Services, the Medicaid
			 fiscal agent, and the accrediting organization.
2. Notice of site closure must state the site
			 closure date;
3. If site closure is
			 permanent, the site certification expires at 12:00 a.m. the day following the
			 closure date stated in the notice;
4. If site closing is temporary, and is for
			 reasons unrelated to adverse governmental action, DHS may suspend the site
			 certification for up to one (1) year if the provider maintains possession and
			 control of the site. If the site Is not operating and in compliance within the
			 time specified in the site certification suspension, the site certification
			 expires at 12:00 a.m. the day after the site certification suspension
			 ends.
B. Unplanned
			 Closings:
1. If a provider must involuntarily
			 close a site due to, for example, fire, natural disaster, or adverse
			 governmental action, the provider must immediately notify clients and families,
			 DHS, the Division of Medical Services, the Medicaid fiscal agent, and the
			 accrediting organization of the closure and the reason(s) for the
			 closure.
2. Site certification
			 expires in accordance with any pending regulatory action, or, if no regulatory
			 action is pending, at 12:00 a.m. the day following permanent closure.
C. All Closings:
1. Providers must assure and document
			 continuity of care for all clients who receive Outpatient Behavioral Health
			 Services at the site;
2. Notice of
			 Closure and Continuing Care Options:
a.
			 Providers must assure and document that clients and families receive actual
			 notice of the closure, the closure date, and any information and instructions
			 necessary for the client to obtain transition services;
b. After documenting that actual notice to a
			 specific client was impossible despite the exercise of due diligence, providers
			 may satisfy the client notice requirement by mailing a notice containing the
			 information described in subsection (a), above, to the last known address
			 provided by the client; and c. Before closing, providers must post a public
			 notice at each site entry. The public notice must include the name and contact
			 information for all Behavioral Health Agencies within a fifty (50) mile radius
			 of the site.
3. An
			 acceptable transition plan is described below:
Transition Plan:
1.
			 Identify and list all certified sites within a 50 mile radius. Include
			 telephone numbers and physical addresses on the list.
2. Provide clients/families with the referral
			 information and have them sign a transfer of records form/release of
			 information to enable records to be transferred to the provider of their
			 choice.
3. Transfer records to the
			 designated provider.
4. Designate a
			 records retrieval process as specified in Section I of tlie Arkansas (Medicaid
			 Outpatient Behavioral Health Services Provider Policy Manual §
			 142.300.
5. Submit a reporting of
			 transfer to DHS (Attn: Policy & Certification Office) including a list of
			 client names and the disposition of each referral. See example below:
Name
Referred to:
Records Transfer Status:
RX Needs Met By:
Johnny
OP Provider Name
to be delivered 4/30/20XX
Provided 1 month RX
Mary
Private Provider Name
Delivered 4/28/20XX
No Meds
Judy
Declined Referral
XX
6. DHS
			 may require additional information regarding documentation of client transfers
			 to ensure that client needs are addressed and met.
DHS BEHAVIORAL HEALTH AGENCY Form 220 shall be used when a site
				is to be closed.
D. New Sites: Use DHS BEHAVIORAL HEALTH
			 AGENCY Form 250 to apply for new sites, which would include a new Medicaid
			 provider ID number for that site,
E. Site Transfer:
1. At least forty-five (45) calendar days
			 before a proposed transfer of an accredited site. the provider must apply to
			 DHS to transfer site certification. The application must include documentation
			 that:
a. The provider notified the accrediting
			 entity, and the accrediting entity has extended or will extend accreditation to
			 the second site; or
b. The
			 accrediting entity has established an accreditation
			 timeframe.
2. The
			 provider must notify clients and families, DHS, the Division of Medical
			 Services, the Medicaid fiscal agent, and the accrediting organization at least
			 thirty (30) calendar days before the transfer;
3. DHS does not require an on-site survey,
			 nor does the Division of Medical Services require a new Medicaid provider
			 number. Please use DHS BEHAVIORAL HEALTH AGENCY Form 220 for a site move or
			 transfers.
F. Site
			 Relocation: The provider must follow the rules for closing the original site,
			 and the rules for opening a new site.
XIII.
PROVIDER RE-CERTIFICATION:
A. The term of DHS site certification is
			 concurrent with the provider's national accreditation cycle, except that site
			 certification extends six (6) months past the accreditation expiration month if
			 there is no interruption in the accreditation. (The six-month extension is to
			 give the Behavioral Health Agency time to receive a final report from the
			 accrediting organization, which the provider must immediately forward to
			 DHS.)
B. Providers must furnish DHS
			 a copy of:
1. Correspondence related to the
			 provider's request for re-accreditation:
a.
			 Providers shall send DHS copies of correspondence from the accrediting agency
			 within five (5) business days of receipt;
b. Providers shall furnish DHS copies of
			 correspondence to the accrediting organization concurrently with sending
			 originals to the accrediting organization.
2. An application for provider and site
			 recertification:
a. DHS must receive provider
			 and site recertification applications at least fifteen (15) business days
			 before the DHS Behavioral Health Agency certification expiration
			 date;
b. The Re-Certification form
			 with required documentation is DHS BEHAVIORAL HEALTH AGENCY Form 230 and is
			 available at
www.arkansas.gov/dhs/dhs
.
C. If DHS has not
			 recertified the provider and site(s) before the certification expiration date,
			 certification is void beginning 12:00 a.m. the next day.
XIV.
MAINTAINING DHS BEHAVIORAL HEALTH
			 AGENCY CERTIFICATION:
A. Providers
			 must:
1. Maintain compliance;
2. Assure that DHS certification information
			 is current, and to that end must notify DHS within thirty (30) calendar days of
			 any change affecting the accuracy of the provider's certification
			 records;
3. Furnish DHS all
			 correspondence in any form (e.g., letter, facsimile, email) to and from the
			 accrediting organization to DHS within thirty (30) calendar days of the date
			 the correspondence was sent or received except:
a. As stated in § XII;
b. Correspondence related to any change of
			 accreditation status, which providers must send to DHS within three (3)
			 calendar days of the date the correspondence was sent or received.
c. Correspondence related to changes in
			 service delivery, site location, or organizational structure, which providers
			 must send to DHS within ten (10) calendar days of the date the correspondence
			 was sent or received.
4.
			 Display the Behavioral Health Agency certificate for each site at a prominent
			 public location within the site
B. Annual Reports:
1. Providers must furnish annual reports to
			 DHS before July 1 of each year that the provider has been in operation for the
			 preceding twelve (12) months. Community Mental Health Centers and specialty
			 clinics may meet this requirement by submitting the Annual Plan/Basic Services
			 Plan to DHS.
2. Annual report shall
			 be prepared by completing forms provided by DHS. Please use DHS BEHAVIORAL
			 HEALTH AGENCY Form 240 for the Behavioral Health Agency annual
			 report.
XV.
NONCOMPLIANCE
A. Failure to
			 comply with this rule may result in one or more of the following:
1. Submission and implementation of an
			 acceptable corrective action plan as a condition of retaining Behavioral Health
			 Agency certification;
2. Suspension
			 of Behavioral Health Agency certification for either a fixed period or until
			 the provider meets all conditions specified in the suspension notice;
3. Termination of Behavioral Health Agency
			 certification.
XVI
APPEAL PROCESS
A. If DHS denies, suspends, or revokes any
			 Behavioral Health Agency certification (takes adverse action), the affected
			 proposed provider or provider may appeal the DHS adverse action. Notice of
			 adverse action shall comply with Ark. Code Ann. §§
											20-77-1701 -1705, and
			 §§1708-1713. Appeals must be submitted in writing to the DHS. The
			 provider has thirty (30) calendar days from the date of the notice of adverse
			 action to appeal. An appeal request received within thirty-five (35) calendar
			 days of the date of the notice will be deemed timely. The appeal must state
			 with particularity the error or errors asserted to have been made by DHS in
			 denying certification, and cite the legal authority for each assertion of
			 error. The provider may elect to continue Medicaid billing under the Behavioral
			 Health Agency program during the appeals process.
			 I f the appeal is denied, the
			 provider must return all monies received for Behavioral Health Agency services
			 provided during the appeals process.
B. Within thirty (30) calendar days after
			 receiving an appeal DHS shall:
(1) designate
			 a person who did not participate in reviewing the application or in the
			 appealed-from adverse decision to hear the appeal;
(2) set a date for the appeal
			 hearing;
(3) notify the appellant in
			 writing of the date, time, and place of the hearing. The hearing shall be set
			 within sixty (60) calendar days of the date DHS receives the request for
			 appeal, unless a party to the appeal requests and receives a continuance for
			 good cause.
C. DHS shall
			 tape record each hearing.
D. The
			 hearing official shall issue the decision within forty-five (45) calendar days
			 of the date that the hearing record is completed and closed. The hearing
			 official shall issue the decision in a written document that contains findings
			 of fact, conclusions of law, and the decision. The findings, conclusions, and
			 decision shall be mailed to the appellant except that if the appellant is
			 represented by counsel, a copy of the findings, conclusions, and decision shall
			 also be mailed to the appellant's counsel. The decision is the final agency
			 determination under the Administrative Procedure Act.
E. Delays caused by the appealing party shall
			 not count against any deadline. Failure to issue a decision within the time
			 required is not a decision on the merits and shall not alter the rights or
			 status of any party to the appeal, except that any party may pursue legal
			 process to compel the hearing official to render a decision.
F. Except to the extent that they are
			 inconsistent with this policy, the appeal procedures in the Arkansas Medicaid
			 Outpatient Behavioral Health Services Provider Manual are incorporated by
			 reference and shall control.