Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.09-031 - State Plan Amendment #2008-019 & Rehabilitative Services for Persons with Mental Illness Update # 110

Current through Register Vol. 49, No. 6, June, 2024
Section
			 II
200.000
REHABILITATIVE
			 SERVICES FOR PERSONS WITH MENTAL ILLNESS (RSPMI)
GENERAL INFORMATION
rehabilitative services for persons with| mental illness
				(rspmi) contents!
201.000
Introduction
Medicaid (Medical Assistance) is designed to assist eligible
				Medicaid beneficiaries in obtaining medical care within the guidelines
				specified in Section I of this manual. Rehabilitative Services for Persons with
				Mental Illness (RSPMI) are covered by Medicaid when provided to eligible
				Medicaid beneficiaries by enrolled providers.
RSPMI may be provided to eligible Medicaid beneficiaries at all
				provider facility certified sites. Certain RSPMI services may be provided off
				site from the provider facility.
202.000
Arkansas Medicaid Participation
			 Requirements for RSPMI
In order to ensure quality and continuity of care, all mental
				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.
To enroll as an RSPMI Medicaid provider, the following must
				occur:
A. Providers must be located
			 within the State of Arkansas.
B. A
			 provider must complete a provider application (form DMS-652), a Medicaid
			 contract (form DMS-653) and a Request for Taxpayer Identification Number and
			 Certification (Form W-9) with the Arkansas Medicaid Program.
View or print a provider application (form DMS-652), Medicaid
			 contract (form DMS-653) and Request for Taxpayer Identification Number and
			 Certification (Form W-9).
C. A provider must be certified by the
			 Division of Behavioral Health Services (DBHS). (See section 202.100 for
			 certification requirements.)
D. A
			 copy of the current DBHS certification as an RSPMI provider must accompany the
			 provider application and Medicaid contract. Subsequent certifications must be
			 provided when issued.
E. Enrollment
			 as a Medicaid provider is conditioned upon approval of a completed provider
			 application and the execution of a Medicaid Provider Contract.
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.
211.000
Coverage of Services
Rehabilitative Services for Persons with Mental
				I llness (RSPMI) are limited to
				certified providers who offer core mental health services for the treatment and
				prevention of mental disorders. The provider must be certified as an RSPMI
				provider by the Division of Behavioral Health Services.
An RSPMI provider must have 24-hour emergency response
				capability to meet the emergency treatment needs of the RSPMI clients they are
				serving. The provider must implement and maintain a written policy reflecting
				the specific coverage plan to meet this requirement. An answering machine
				message to call 911 or report to the nearest emergency room in and of itself is
				not sufficient to meet the requirement.
218.000
Master Treatment Plan
For each beneficiary entering the RSPMI Program, the treatment
				team must develop an individualized master treatment plan. This consists of a
				written, individualized plan to treat, ameliorate, diminish or stabilize or
				maintain remission of symptoms of mental illness that threaten life, or cause
				pain or suffering, resulting in diminished or impaired functional capacity. The
				master treatment plan goals and objectives must be based on problems identified
				in the intake assessment or in subsequent assessments during the treatment
				process. The master treatment plan must be included in the beneficiary records
				and contain a written description of the treatment objectives for that
				beneficiary. It also must describe:
A.
			 The treatment regimen-the specific medical and remedial services, therapies and
			 activities that will be used to meet the treatment objectives;
B. A projected schedule for service
			 delivery-this includes the expected frequency and duration of each type of
			 planned therapeutic session or encounter;
C. The type of personnel that will be
			 furnishing the services and
D. A
			 projected schedule for completing reevaluations of the patient's condition and
			 updating the master treatment plan.
The RSPMI master treatment plan must be completed by a mental
				health professional and approved by a psychiatrist or physician, within 14
				calendar days of the individual's entering care (first billable service).
				Subsequent revisions in the master treatment plan will be approved in writing
				(signed and dated) by the psychiatrist or physician verifying continued medical
				necessity.
219.100
Outpatient Services
RSPMI outpatient services, based on a plan of care, include a
				broad range of services to Medicaid-eligible beneficiaries. Beneficiaries shall
				be served with an array of treatment services outlined on their individualized
				master treatment plan in an amount and duration designed to meet their medical
				needs.
219.110
Daily
			 Limit of Beneficiary Services
Medicaid Beneficiaries will be limited to a maximum of eight
				hours per 24 hour day of outpatient services with the exception of Crisis
				Intervention, Crisis Stabilization Intervention by Mental Health Professional
				and Crisis Stabilization Intervention by Mental Health Paraprofessional.
				Beneficiaries will be eligible for an extension of the daily maximum amount of
				services based on a medical necessity review by the contracted utilization
				management entity (See Section
				231.100 for details regarding
				extension of benefits).
223.000
Exclusions
Services not covered under the RSPMI Program include, but are
				not limited to:
A. Room and board
			 residential costs;
B. Educational
			 services;
C. Telephone contacts
			 with patient or collateral;
D.
			 Transportation services, including time spent transporting a beneficiary for
			 services
(reimbursement for other RSPMI 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, except for testing
			 purposes;
F. RSPMI services which
			 are found not to be medically necessary and
G. RSPMI services provided to nursing home
			 and ICF/MR residents other than those specified in section
			 252.150.
226.200
Documentation
The RSPMI provider must develop and maintain sufficient written
				documentation to support each medical or remedial therapy, service, activity or
				session for which Medicaid reimbursement is sought. This documentation, at a
				minimum, must consist of:
A. Must be
			 individualized to the beneficiary and specific to the services provided,
			 duplicated notes are not allowed.
B. The date and actual time the services were
			 provided (Time frames may not overlap between services. All services must be
			 outside the time frame of other services.),
C. Name and credentials of the person, who
			 provided the services,
D. The
			 setting in which the services were provided. For all settings other than the
			 provider's enrolled sites, the name and physical address of the place of
			 service must be included,
E. The
			 relationship of the services to the treatment regimen described in the plan of
			 care and
F. Updates describing the
			 patient's progress and
G. For
			 services that require contact with anyone other than the beneficiary, evidence
			 of conformance with HIPAA regulations, including presence in documentation of
			 Specific Authorizations, is required.
Documentation must be legible and concise. The name and title
				of the person providing the service must reflect the appropriate professional
				level in accordance with the staffing requirements found in section
				213.000.
For Therapeutic Day/Acute Day and Rehabilitative Day Services,
				progress notes must be entered daily. Daily notes may be brief; however, they
				must meet requirement of item F above.
Providers may enter weekly progress notes that summarize the
				beneficiary's progress in relationship to the plan of care.
All documentation must be available to representatives of the
				Division of Medical Services at the time of an audit by the Medicaid Program
				Integrity Unit. All documentation must be available at the provider's place of
				business. No more than thirty (30) days will be allowed after the date on the
				recoupment notice in which additional documentation will be accepted.
				Additional documentation will not be accepted after the 30-day period.
227.000
Medical
			 Necessity
All RSPMI services must be medically necessary.
227.001
Prescription for
			 RSPMI Services
Medicaid will not cover any RSPMI service without a current
				prescription signed by a psychiatrist or physician. Prescriptions shall be
				based on consideration of the RSPMI Assessment and proposed master treatment
				plan and an evaluation of the enrolled beneficiary (directly or through review
				of the medical records and consultation with the treatment staff). The
				prescription of the services will be documented by the psychiatrist's or
				physician's written approval of the RSPMI master treatment plan. Subsequent
				revisions of the patient's RSPMI master treatment plan will also be documented
				by the psychiatrist's or physician's written approval in the enrolled
				beneficiary's medical record. Approval of all updates or revisions to the
				Master treatment plan must be documented within 14 calendar days by the
				physician's dated signature on the revised document.
227.100
Prescription for Speech Therapy
Speech therapy services are available to Medicaid-eligible
				beneficiaries. Providers of speech therapy services are required to have a
				physician prescription for services in each patient's record.
A written prescription is required for speech therapy services,
				signed and dated by the PCP or the attending physician. Form DMS-640 is
				required for the prescription. The form must be in the patient's record.
View or print form DMS-640.
A. The beneficiary's PCP or attending
			 physician must sign the prescription.
B. A prescription for speech therapy services
			 is valid for 1 year unless the prescribing physician specifies a shorter period
			 of time.
231.000
Introduction to Prior Authorization and Extension of Benefits
The Division of Medical Services contracts with First Health
				Services and APS Healthcare to complete the prior authorization and extension
				of benefit processes.
When a provider requests PA for services to be provided via
				telemedicine, the procedure codes and modifiers (if any) listed below must be
				shown on the claim form, "telemedicine" must be specified on the
				request.
A request for prior authorization for services to be provided
				to a foster child must specify that the request is for a foster child. A
				request for services to be provided to a child in the custody of the Division
				of Youth Services (DYS) must specify DYS custody.
231.100
Prior Authorization and
			 Extension of Benefits
Prior Authorization is required for certain services provided
				to Medicaid-eligible individuals. Extension of benefits is required for all
				other services when the maximum benefit for the service is exhausted. Yearly
				service benefits are based on the state fiscal year running from July 1 to June
				30. Extension of Benefits is also required whenever a beneficiary exceeds eight
				hours of outpatient services in one 24-hour day, with the exception of crisis
				intervention, crisis stabilization intervention by a mental health
				professional, and crisis stabilization intervention by paraprofessional.
Prior authorization and extension requests must be sent to APS
				Healthcare for beneficiaries under the age of 21.
View or
				print APS Healthcare contact information.
Information
				related to clinical management guidelines and authorization request processes
				is available at
www.apshealthcare.com
.
Prior authorization and extension requests must be sent to
				First Health for beneficiaries age 21 and over.
View or print
				First Health contact information.
Information related to
				clinical management guidelines and authorization request processes is available
				at
https://arkansas.fhsc.com/
Procedure codes requiring prior
				authorization:
National Codes
Required Modifier
Service Title
90846 90846 90846
HA, U3,
U5 (telemedicine)
Marital/Family Therapy without patient present
90853 90853
HA, U1
Group Outpatient - Group Psychotherapy
90862
HA, HQ
Group Outpatient-Pharmacologic Management by
						  Physician
H2012 H2012
HA UA
Therapeutic Day/Acute Day Treatment
90887 90887
HA, U1
Collateral Intervention, MHP
90887
HA, UB
Collateral Intervention, MHPP
H2015 H2015
H2015
HA, U5 U6
U7 (telemedicine)
Intervention, MHP
H2015 H2015
HA, U1 U2
Intervention, MHPP
H2017 H2017
HA, U1
Rehabilitative Day Service
90801 90801
HA, Ul
Mental Health Evaluation/Diagnosis
16
96101
HA, UA
Psychological Evaluation
32
90885
HA, U2
Master Treatment Plan
8
90887 90887
HA, U2 U3
Interpretation of Diagnosis
16
H0004 H0004
HA
Individual Psychotherapy
48
90847 90847 90847
HA, U3
U5 (telemedicine)
Marital/Family Therapy with patient present
48
H2011 H2011
HA, U7
U4 (telemedicine)
Crisis Intervention
72
T1023 T1023
HA, U1
Diagnostic Assessment by Physician (Formerly Assessment
						  and Treatment Plan/Plan of Care)
1
99201 99202 99203 99204 99205 99212 99213 99214
						  99215
AND
99201 99202 99203 99204 99205 99212 99213 99214
						  99215
HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB HA, UB
						  HA, UB
HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA
						  HA, SA
Physical Examination
12
90862 90862 90862
HA HA, UB
Pharmacologic Management
24
90885 90885
HA HA, U1
Periodic Review of Master treatment plan
10
36415
HA
Routine Venipuncture for Collection of Specimen
12
H2011 H2011
HA, U6 U2
Crisis Stabilization, MHP
72
H2011 H2011
HA, U5 U1
Crisis Stabilization, MHPP
72
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 Medicaid prior to rendering
				services.
A. Outpatient Services
Fifteen-Minute Units
RSPMI services are billed on a per unit basis. A unit of
				service for an outpatient service is fifteen (15) minutes unless otherwise
				stated. Any unit less than five (5) minutes in duration is not considered a
				valid length of service and should not be submitted to Medicaid for payment. To
				determine how many units should be submitted on the claim, follow these steps.
				Begin by totaling the number of minutes of service rendered and divide by
				fifteen (15). If the remainder is five (5) or greater, round up to the next
				highest unit, but if the remainder is less than five (5), the quotient will be
				the valid units of service.
Providers may collectively bill for a single date of service
				but may not collectively bill for spanning dates of service. For example, an
				RSPMI service may occur on behalf of a beneficiary on Monday and then again on
				Tuesday. The RSPMI provider may bill for the total amount of time spent on
				Monday and the total amount of time spent on Tuesday but may not bill for the
				total amount of time spent both days as a single date of service. The maximum
				allowable for a procedure is the same for all RSPMI providers.
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).
252.100
Procedure
			 Codes for Types of Covered Services
Covered RSPMI services are outpatient services. Specific RSPMI
				services are available to inpatient hospital patients (as outlined in Section
				240.000 and
				220.100 ), through telemedicine,
				and to nursing home and ICF/MR residents. RSPMI services are billed on a per
				unit basis. Unless otherwise specified in this manual or the appropriate CPT or
				HCPCS book, one unit equals 15 minutes. All services must be provided by at
				least the minimum staff within the licensed or certified scope of practice to
				provide the service.
NOTE: RSPMI providers will continue to use modifiers 22
				and 52. Effective for claims received on or after December 5, 2005, modifier 22
				will be replaced with UA and modifier 52 will be replaced with
				UB.
252.110
Outpatient Procedure Codes
National Code
Required Modifier
Definition
92506
HA
Diagnosis: Speech
						  Evaluation
1 unit = 30 minutes
Maximum units per day: 4
Maximum units per state fiscal year (SFY) = 4
						  units
90801
HA, Ul
SERVICE: Mental Health Evaluation/Diagnosis
						  (Formerly known only as Diagnosis,)
DEFINITION:
The cultural, developmental,
						  age and disability -relevant clinical evaluation and determination of a
						  beneficiary's mental status; functioning in various life domains; and an axis
						  five DSM diagnostic formulation for the purpose of developing a plan of care.
						  This service is required prior to provision of all other mental health services
						  with the exception of crisis interventions. Services are to be congruent with
						  the age, strengths, necessary, accommodations for disability, and cultural
						  framework of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8,
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 16
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); Nursing Facility (32); Skilled Nursing Facility (31);
						  School (03); Homeless Shelter (04); Assisted Living Facility (13); Group Home
						  (14); ICF/MR (54)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
. 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)
* Culturally- and age-appropriate psychosocial history
						  and assessment
* Mental status/Clinical observations and
						  impressions
* Current functioning and strengths in specified life
						  domains . Five axis DSM diagnostic impressions
* Treatment recommendations
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
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. Prior
						  Authorization requests, master treatment plans, etc.).
90801
Mental Health Evaluation/Diagnosis:
Use
						  the above description
Additional requirement: 90801 with no modifier is for
						  service provided via telemedicine only. Note: Telemedicine POS 99
96101
HA, UA
SERVICE: Psychological Evaluation (Formerly
						  Diagnosis - Psychological Test/Evaluation and Diagnosis - Psychological Testing
						  Battery)
DEFINITION:
A Psychological Evaluation
						  employs standardized psychological tests conducted and documented for
						  evaluation, diagnostic, or therapeutic purposes. The evaluation must be
						  medically necessary, culturally relevant; with reasonable accommodations for
						  any disability, provide information relevant to the beneficiary's continuation
						  in treatment, and assist in treatment planning. All psychometric instruments
						  must be administered, scored, and interpreted by the qualified
						  professional.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  16
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 32
ALLOWABLE PLACES OF SERVICE:
Office
						  (11)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* 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
* Axis Five DSM diagnostic impressions
* Treatment recommendations and findings related to
						  rationale for service and guided by the master treatment plan and test
						  results
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
Medical necessity for
						  this service is met when the service is necessary to establish a differential
						  diagnosis of behavioral or psychiatric conditions, when the history and
						  symptomatology are not readily attributable to a particular psychiatric
						  diagnosis and the questions to be answered by the evaluation could not be
						  resolved by a psychiatric/diagnostic interview, observation in therapy, or an
						  assessment for level of care at a mental health facility,
Or
T1023
HA, U1
Medical necessity is met when the beneficiary has
						  demonstrated a complexity of issues related to cognitive functioning or the
						  impact of a disability on a condition or behavior and the service is necessary
						  to develop treatment recommendations after the beneficiary has received various
						  treatment services and modalities, has not progressed in treatment, and
						  continues to be symptomatic.
Medicaid WILL NOT reimburse evaluations or testing that
						  is considered primarily educational. Such services are those used to identify
						  specific learning disabilities and developmental disabilities in beneficiaries
						  who have no presenting behavioral or psychiatric symptoms which meet the need
						  for mental health treatment evaluation. This type of evaluation and testing is
						  provided by local school systems under applicable state and federal laws and
						  rules. Psychological Evaluation services that are ordered strictly as a result
						  of court-ordered services are not covered unless medical necessity criteria are
						  met. Psychological Evaluation services for employment, disability
						  qualification, or legal/court related purposes are not reimbursable by Medicaid
						  as they are not considered treatment of illness. A Psychological Evaluation
						  report must be completed within fourteen (14) calendar days of the examination;
						  documented; clearly identified as such; and signed/dated by the staff
						  completing the evaluation. This service constitutes both face to face time
						  administering tests to the beneficiary and time interpreting these test results
						  and preparing the report.
SERVICE: Diagnostic Assessment by Physician
						  (Formerly Assessment and Treatment Plan/Plan of Care) DEFINITION:
A
						  direct face-to-face service contact occurring between the physician and the
						  beneficiary for the process of certifying the beneficiary as SED or SMI and
						  determining the need for RSPMI services for a specified time period.
						  Eligibility for these services must be based on diagnosis, past psychiatric
						  history, level of functioning and current support needs. The plan must provide
						  for the least restrictive medically necessary treatment that may reasonably be
						  expected to benefit the beneficiary. (See Section
						  224.000 for additional
						  requirements.)
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
This
						  service must be billed as 1 per episode.
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
May be billed one (1) time upon initial admission to RSPMI services and once
						  yearly thereafter.
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); and for ages 21 and over, RSPMI Clinic
						  (Telemedicine) (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS:
Date of Service
Start and stop times
Place of service
Diagnosis
Diagnostic Impression
Psychiatric (re)assessment
Functional (re)assessment
Discharge criteria
Physician's signature indicating medical
						  necessity/credentials/date of signature
NOTES and COMMENTS:
The beneficiary must
						  be reassessed, reviewed, and recertified at least every year or in accordance
						  with Division of Behavior Health Services certification requirements. The DBHS
						  Physician Certification form must be completed and filed in the beneficiary's
						  record, or all of the equivalent information covered and documented in the
						  record.
T1023
SERVICE: Diagnostic Assessment by Physician
						  (Formerly Assessment and Treatment Plan/Plan of Care):
Use the above description.
T1023 with no modifier is for services provided via
						  telemedicine only.
90885
HA, U2
SERVICE: Master Treatment Plan
DEFINITION:
A developed plan in cooperation
						  with the beneficiary
(parent or guardian if the beneficiary is under 18), to
						  deliver specific mental health services to the beneficiary to restore, improve
						  or stabilize the beneficiary's mental health condition. The plan must be based
						  on individualized service needs identified in the completed Mental
						  Health
Diagnostic Evaluation. The plan must include goals for
						  the medically necessary treatment of identified problems, symptoms and mental
						  health conditions. The plan must identify individuals or treatment teams
						  responsible for treatment, specific treatment modalities prescribed for the
						  beneficiary, time limitations for services, and documentation of medical
						  necessity by the supervising physician
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 8
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); Nursing Facility (32); Skilled Nursing Facility
						  (31); School (03);
Homeless Shelter (04); Assisted Living Facility (13);
						  Group Home (14);
ICF/MR (54);
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
. Date of Service (date plan is developed)
* Start and stop times for development of plan
* Place of service . Diagnosis
* Beneficiary's strengths and needs
* Treatment goal(s) developed in cooperation with and
						  as stated by beneficiary that are related specifically to the
						  beneficiary's
strengths and needs
* Measurable objectives
. Treatment modalities - The specific services that
						  will be used to meet the measurable objectives
* Projected schedule for service delivery, including
						  amount, scope, and duration
* Credentials of staff who will be providing the
						  services
* Discharge criteria
. Signature/credentials of staff drafting the document
						  and primary staff who will be delivering or supervising the delivery of the
						  specific services/ date of signature(s)
. Beneficiary's signature (or signature of parent,
						  guardian, or custodian of beneficiaries under the age of 18)/ date of
						  signature
* Physician's signature indicating medical necessity
						  /date of signature
NOTES and COMMENTS:
This service may be
						  billed one (1) time upon entering care and once yearly thereafter. The master
						  treatment plan must be reviewed every ninety (90) calendar days or more
						  frequently if there is documentation of significant acuity changes in clinical
						  status requiring an update/change in the beneficiary's master treatment plan.
						  It is the responsibility of the primary mental health professional to insure
						  that all paraprofessionals working with the client have a clear understanding
						  and work toward the goals and objectives stated on the treatment plan.
90885
HA
SERVICE: Periodic Review of Master Treatment
						  Plan
DEFINITION:
The periodic review and
						  revision of the master treatment plan, in cooperation with the beneficiary, to
						  determine the beneficiary's progress or lack of progress toward the master
						  treatment plan goals and objectives; the efficacy of the services provided; and
						  continued medical necessity of services. This includes a review and revision of
						  the measurable goals and measurable objectives directed at the medically
						  necessary treatment of identified symptoms/mental health condition,
individuals or treatment teams responsible for
						  treatment, specific treatment modalities, and necessary accommodations that
						  will be provided to the beneficiary, time limitations for services, and the
						  medical necessity of continued services. Services are to be congruent with the
						  age, strengths, necessary accommodations for any disability, and cultural
						  framework of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  2
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 10
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); Nursing Facility (32); Skilled Nursing Facility
						  (31); School (03);
Homeless Shelter (04); Assisted Living Facility (13);
						  Group Home (14);
ICF/MR (54)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
Completed by the primary MHP (If not, then must
						  have a rationale for another MHP completing the documentation and only with
						  input from the primary MHP)
* Date of service
* Start and stop times for review and revision of
						  plan
* Place of service
* Diagnosis and pertinent interval history
* Beneficiary's updated strengths and needs
* Progress/Regression with regard to treatment goal(s)
						  as documented in the master.
* Progress/Regression of the measurable objectives as
						  documented in the master treatment plan
* Individualized rationale to support the medical
						  necessity of continued services
* Updated schedule for service delivery, including
						  amount, scope, and duration
* Credentials of staff who will be providing the
						  services
* Modifications to discharge criteria
* Signature/credentials of staff drafting the document
						  and primary staff who will be delivering or supervising the delivery of the
						  specific services/date of signature(s)
* Beneficiary's signature (or signature of parent,
						  guardian, or custodian of beneficiaries under the age of 18)/date of
						  signature(s)
* Physician's signature indicating continued medical
						  necessity/date of signature
NOTES and COMMENTS:
This service must be
						  provided every ninety (90) days or more frequently if there is documentation of
						  significant change in acuity or change in clinical status requiring an
						  update/change in the beneficiary's master treatment plan. If progress is not
						  documented, then modifications should be made in the master treatment plan or
						  rationale why continuing to provide the same type and amount of services is
						  expected to achieve progress/outcome. It is the responsibility of the primary
						  mental health professional to insure that all paraprofessionals working with
						  the client have a clear understanding and work toward the goals and objectives
						  stated on the treatment plan.
90885
HA, U1
Periodic Review of Master Treatment
						  Plan
Apply the above description.
Additional information: 90885 plus modifier "U1" is for
						  this service when provided by a non-physician.
90887
HA, U2
SERVICE: Interpretation of
						  Diagnosis
DEFINITION:
A face-to face therapeutic
						  intervention provided to a beneficiary in which the
						  results/implications/diagnoses from a mental health diagnosis evaluation or a
						  psychological evaluation are explained by the professional who administered the
						  evaluation. Services are to be congruent with the age, strengths, necessary
						  accommodations, and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 16
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); Nursing Facility (32); Skilled Nursing Facility
						  (31); School (03); Homeless Shelter (04); Assisted Living Facility (13); Group
						  Home (14); ICF/MR (54); if above the age of 21 RSPMI Clinic
						  (Telemedicine)(99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* 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 intervention used that must
						  coincide with the master treatment plan or proposed master treatment plan or
						  recommendations.
* Participant response and feedback
* Any changes or revision to the master treatment plan,
						  diagnosis, or medication(s)
. Staff signature/credentials/date of
						  signature(s)
NOTES AND COMMENTS:
For beneficiaries under
						  the age of 18, the time may be spent face-to-face with the beneficiary; the
						  beneficiary and the parent(s) orguardian(s); or alone with the parent(s)
						  orguardian(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.
90887
U3
Interpretation of Diagnosis
Use above description
Additional information: 90887 plus modifier "U3" is for
						  service provided via telemedicine only. Note: Telemedicine POS 99
H0004
HA
SERVICE: Individual Psychotherapy
DEFINITION
Face-to-face treatment provided
						  by a licensed mental health professional on an individual basis. Services
						  consist of structured sessions that work toward achieving mutually defined
						  goals as documented in the master Services are to be congruent with the
						  age,
strengths, needed accommodations necessary for any
						  disability, and cultural framework of the beneficiary and his/her family. The
						  treatment service must reduce or alleviate identified symptoms, maintain or
						  improve level of functioning, or prevent deterioration.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 48
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); Nursing Facility (32); Skilled Nursing Facility
						  (31) School (03);
Homeless Shelter (04); Assisted Living Facility (13);
						  Group Home (14);
ICF/MR (54); and forages 21 and over, RSPMI Clinic
						  (Telemedicine)
(99).
AGE GROUP(S):
Ages 21 and over; U21, but
						  not for beneficiaries under the age of 3 except in documented exceptional
						  cases
REQUIRED DOCUMENTATION (See Section
						  226.200 for additional
						  requirements):
* 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 intervention used
						  that must coincide with the master
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Any revisions indicated for the master treatment
						  plan, diagnosis, or medication(s)
* Plan for next individual therapy session, including
						  any homework assignments and/or advanced psychiatric directive
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Services provided must
						  be congruent with the objectives and interventions articulated on the most
						  recent treatment plan. 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.
H0004
Individual Psychotherapy
Use above description.
Additional information: H0004 with no modifier is for
						  ages 21 and over.
H0004
Individual Psychotherapy
Use above description.
Additional information: H0004 with no modifier is for
						  services provided via telemedicine only.
90846
HA, U3
SERVICE: Marital/Family Psychotherapy -
						  Beneficiary is not present
DEFINITION:
Face-to-face treatment
						  provided to more than one member of a family simultaneously in the same session
						  or treatment with an individual family member (i.e. Spouse or Single Parent)
						  that is specifically related to achieving goals identified on the beneficiary's
						  master treatment plan. The identified beneficiary is not present for this
						  service. Services are to be congruent with the age, strengths, needed
						  accommodations for any disability, and cultural framework of the beneficiary
						  and his/her family. These services identify and address marital/family dynamics
						  and improve/strengthen marital/family interactions and functioning in
						  relationship to the beneficiary, the beneficiary's condition and the
						  condition's impact on the marital/family relationship.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
REQUIRES PRIOR AUTHORIZATION
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); and for ages 21 and over, RSPMI Clinic
						  (Telemedicine) (99),
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* Date of Service
. Start and stop times of actual encounter with
						  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 intervention used that must
						  coincide with the master treatment plan 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 intervention 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
. HIPPA compliant Release of information forms,
						  completed, signed and dated
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
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.
90846
Marital/Family Psychotherapy - Beneficiary is not
						  present
Use the above description.
Additional information: 90846 with no modifier is for
						  ages 21 and over.
90846
U5
Marital/Family Psychotherapy - Beneficiary is not
						  present
Use the above description.
Additional information: 90846 with the modifier "U5" is
						  for a service provided via telemedicine only.
90847
HA, U3
SERVICE: Marital/Family Psychotherapy -
						  Beneficiary is present DEFINITION:
Face-to-face treatment provided to
						  more than one member of a family simultaneously in the same session or
						  treatment with an individual family member (i.e. Spouse or Single Parent) that
						  is specifically related to achieving goals identified on the beneficiary's
						  master treatment plan. The identified beneficiary must be present for this
						  service. Services are to be congruent with the age, strengths, needed
						  accommodations for disability, and cultural framework of the beneficiary and
						  his/her family. These services are to be utilized to identify and address
						  marital/family dynamics and improve/strengthen marital/family interactions and
						  functioning in relationship to the beneficiary, the beneficiary's condition and
						  the condition's impact on the marital/family relationship.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 48
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); and forages 21 and over, RSPMI Clinic
						  (Telemedicine) (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* 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 intervention used
						  that must coincide with the master treatment plan 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
						  intervention 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
* Staff signature/credentials/date of signature
. HIPAA compliant release of Information, completed,
						  signed and dated
NOTES and COMMENTS:
Natural supports may be
						  included in these sessions if justified in service documentation and if
						  supported in the master treatment plan. Only one beneficiary per family per
						  therapy session may be billed.
Additional information: 90847 plus modifiers "HA U3" is
						  for under age 21.
90847
Marital/Family Psychotherapy - Beneficiary is
						  present
Use the above description.
Additional information: 90847 with no modifier is for
						  ages 21 and over.
90847
U5
Marital/Family Psychotherapy - Beneficiary is
						  present
Use the above description.
Additional information: 90847 with the modifier "U5" is
						  for a service provided via telemedicine only.
92507
HA
Individual Outpatient - Speech Therapy, Speech
						  Language Pathologist
Scheduled individual outpatient care provided by a
						  licensed speech pathologist supervised by a physician to a Medicaid-eligible
						  beneficiary for the purpose of treatment and remediation of a communicative
						  disorder deemed medically necessary. See the Occupational, Physical and Speech
						  Therapy Program Provider Manual for specifics of the speech therapy
						  services.
92507
HA, UB
Individual Outpatient - Speech Therapy, Speech
						  Language Pathologist Assistant
Scheduled individual outpatient care provided by a
						  licensed speech pathologist assistant supervised by a qualified speech language
						  pathologist to a Medicaid-eligible beneficiary for the purpose of treatment and
						  remediation of a communicative disorder deemed medically necessary. See the
						  Occupational, Physical and Speech Therapy Program Provider Manual for specifics
						  of the speech therapy services.
92508
HA
Group Outpatient- Speech Therapy, Speech Language
						  Pathologist
Contact between a group of Medicaid-eligible
						  beneficiaries and a speech pathologist for the purpose of speech therapy and
						  remediation. See the Occupational, Physical and Speech Therapy Provider Manual
						  for specifics of the speech therapy services.
92508
HA, UB
Group Outpatient- Speech Therapy, Speech Language
						  Pathologist Assistant
Contact between a group of Medicaid-eligible
						  beneficiaries and a speech pathologist assistant for the purpose of speech
						  therapy and remediation. See the Occupational, Physical and Speech Therapy
						  Provider Manual for specifics of the speech therapy services.
90853
HA, U1
SERVICE: Group Outpatient - Group
						  Psychotherapy
DEFINITION:
Face-to-face interventions
						  provided to a group of beneficiaries on a regularly scheduled basis to improve
						  behavioral or cognitive problems which either cause or exacerbate mental
						  illness. The professional uses the emotional interactions of the group's
						  members to assist them in implementing each beneficiary's master treatment
						  plan.
Services are to be congruent with the age, strengths,
						  needed accommodation for any disability, and cultural framework of the
						  beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  School (03);
Homeless Shelter (04); Assisted Living Facility (13);
						  Group Home (14);
AGE GROUP(S):
Ages 21 and over; Ages 4 -
						  20; Under age 4 by prior authorized medically needy exception
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* 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 intervention and intervention
						  used that must coincide with master treatment plan
* Beneficiary's response to the group intervention that
						  includes current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Plan for next group session, including any homework
						  assignments
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
This does NOT include
psychosocial groups.
Beneficiaries eligible for Group
						  Outpatient- Group Psychotherapy 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 21 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 21 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,
90853
Group Outpatient - Group
						  Psychotherapy
Apply the above description.
Additional information: 90853 with no modifier is for
						  ages 21 and over.
H2012
HA
SERVICE: Therapeutic Day/Acute Day Treatment
						  DEFINITION:
Short-term daily array of continuous, highly structured,
						  intensive outpatient services provided by a mental health professional. These
						  services are for beneficiaries experiencing acute psychiatric symptoms that may
						  result in the beneficiary being in imminent danger of psychiatric
						  hospitalization and are designed to stabilize the acute symptoms. These direct
						  therapy and medical services are intended to be an alternative to inpatient
						  psychiatric care and are expected to reasonably improve or maintain the
						  beneficiary's condition and functional level to prevent hospitalization and
						  assist with assimilation to his/her community after an inpatient psychiatric
						  stay of any length. These services are to be provided by a team consisting of
						  mental health clinicians, paraprofessionals and nurses, with physician
						  oversight and availability. The team composition may vary depending on clinical
						  and programmatic needs but must at a minimum include a licensed mental health
						  clinician and physician who provides services and oversight.
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 must include constant staff supervision
						  of beneficiaries and physician oversight.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  32
PRIOR AUTHORIZATION REQUIRED ALLOWABLE PLACES OF
						  SERVICE:
Office (11)
STAFF to CLIENT RATIO:
1:5 for ages 21 and
						  over; 1:4 for U21
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* Start and stop times of actual program participation
						  by beneficiary
* Place of service
. Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and interventions used that must
						  coincide with the master treatment plan
* Beneficiary's response to the intervention must
						  include current progress or lack of progress toward symptom reduction and
						  attainment of goals
* Rationale for continued acute day service, including
						  necessary changes to diagnosis, master treatment plan or medication(s)
* Staff signature/credentials
NOTES and COMMENTS:
Providers may bill for
						  services only at times during which beneficiaries participate in program
						  activities. Providers are expected to sign patients in and out of the program
						  to provide medically necessary treatment therapies. However, in order to be
						  claimed separately, these therapies must be identified on the Master Treatment
						  Plan and serve a treatment purpose which cannot be accomplished within the day
						  treatment setting.
See Section
						  219.110 for additional
						  information.
H2012
UA
Therapeutic Day/Acute Day Treatment
- 8
						  units minimum See Section
						  219.110 for additional
						  information.
H2011
HA, U7
SERVICE: Crisis Intervention
DEFINITION:
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.)
DAILY MAXIMUM OF UNITS THAT MAY
						  BE BILLED: 12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); Nursing Facility (32); Skilled Nursing Facility
						  (31); School (03);
Homeless Shelter (04); Assisted Living Facility (13);
						  Group Home (14);
ICF/MR (54); RSPMI Clinic (Forages 21 and over)
						  (Telemedicine) (99);
Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for additional
						  requirements):
* Date of Service
* Start and stop time of actual encounter with
						  beneficiary and possible collateral contacts with caregivers or informed
						  persons
* Place of service (If 99 is used, specific location
						  and rationale for location must be included)
* 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 and COMMENTS:
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.
H2011
U4
Crisis Intervention
Apply the above description.
Additional information: H2011 plus modifier "U4" is for
						  service provided via telemedicine only.
Physicia
m
99201 99202 99203 99204 99211
99212 99213
HA, UB HA, UB HA, UB HA, UB HA, UB
HA, UB HA, UB HA, UB
SERVICE: Physical Examination - Psychiatrist or
						  Physician
Physical Examination - Psychiatric Mental Health
						  Clinical Nurse
Specialist or Psychiatric Mental Health Advanced
						  Nurse Practitioner
DEFINITION:
A general multisystem
						  examination based on age and risk factors to determine the state of health of
						  an enrolled RSPMI beneficiary.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  1
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 12
ALLOWABLE PLACES OF SERVICE:
Office
						  (11)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
99214
PCNS& PANP:
99201
99202
99203
99204
99211
99212
99213
99214
HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA HA, SA HA,
						  SA
additional requirements):
* Start and stop times of actual encounter with
						  beneficiary . Date of service
* Place of service
* Identifying information
. Referral reason and rationale for examination
* Presenting problem(s)
* Health history
. Physical examination
* Laboratory and diagnostic procedures ordered
* Health education/counseling . Identification of risk
						  factors
* Mental status/clinical observations and
						  impressions
* ICD-9 diagnoses
* Five axis DSM diagnostic impressions
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Treatment recommendations for findings, medications
						  prescribed, and indicated informed consents
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
This service may be
						  billed only by the RSPMI provider. The physician, Psychiatric Mental Health
						  Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner may not bill for an office visit, nursing home visit, or any other
						  outpatient medical services procedure for the beneficiary for the same date of
						  service. Pharmacologic Management may not be billed on the same date of service
						  as Physical Examination, as pharmacologic management would be considered one
						  component of the full physical examination (office visit).
90862
HA
SERVICE: Pharmacologic Management by Physician
						  (formerly Medication Maintenance by a physician)
Pharmacologic Management by Mental Health
						  Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner
DEFINITION:
Provision of service tailored
						  to reduce, stabilize or eliminate psychiatric symptoms by addressing individual
						  goals in the master treatment plan. 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, necessary
						  accommodations for any disability, and cultural framework of the beneficiary
						  and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 2
						  YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED without extension: 24
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home (12); School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group Home (14); and if age 21 and over, RSPMI Clinic
						  (Telemedicine) (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS(See Section
						  226.200 for
additional requirements):
* Date of Service
* Start and stop times of actual encounter with
						  beneficiary
. Place of service (If 99 is used for telemedicine,
						  specific locations and rationale for using telemedicine must be
						  included)
* Diagnosis and pertinent interval history . Brief
						  mental status and observations
* Rationale for and intervention used that must
						  coincide with the master treatment plan
. Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Revisions indicated for the master treatment plan,
						  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
* Staff signature/credentials/date of signature
NOTES and COMMENTS:
Applies only to
						  medications prescribed to address targeted symptoms as identified in the master
						  treatment plan.
90862
Pharmacologic Management by
						  Physician
Apply description above.
Additional information: 90862 with no modifier is
						  forages 21 and over.
90862
Pharmacologic Management by
						  Physician
Apply description above.
Additional information: 90862 with no modifier is for
						  services provided via telemedicine only.
90862
HA, UB
Pharmacologic Management by Psychiatric Mental
						  Health Clinical Nurse Specialist or Psychiatric Mental Health Advanced Nurse
						  Practitioner
Apply description above.
T1502
SERVICE: Medication Administration by a Licensed
						  Nurse
DEFINITION:
Administration of a
						  physician-prescribed medication to a beneficiary. This includes preparing the
						  beneficiary and medication;
actual administration of oral, intramuscular and/or
						  subcutaneous medication; observation of the beneficiary after administration
						  and any possible adverse reactions; and returning the medication to its
						  previous storage.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED
						  1
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of Service
. Start and stop times of the specific procedure
* Place of service
* Diagnosis and pertinent interval history . Brief
						  mental status and observations
* Rationale for dosing schedule and intervention used
						  must coincide with the master treatment plan
. Beneficiary's response to intervention that includes
						  current progress or regression, prognosis, and reaction to medication
* Revisions indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Plan for follow-up services, including any crisis
						  plans
* Staff signature/credentials/date of signature
NOTES and COMMENTS: Applies only to medications
						  prescribed to address targeted symptoms as identified in the master treatment
						  plan.
Drugs and biologicals that can be self-administered shall not be in
						  this group unless there is a documented reason the patient cannot self
						  administer. Non-prescriptions and biologicals purchased by or dispensed to a
						  patient are not covered.
90862
HA, HQ
SERVICE: Group Outpatient - Pharmacologic
						  Management by a
Physician
DEFINITION:
Therapeutic intervention
						  provided to a group of beneficiaries by a licensed physician involving
						  evaluation and maintenance of the Medicaid-eligible beneficiary on a medication
						  regimen with simultaneous supportive psychotherapy in a group setting.
This includes evaluating medication prescription,
						  administration,
monitoring, and supervision; and informing
						  beneficiaries regarding medication(s) and its potential effects and side
						  effects. Services are to be congruent with the age, strengths, necessary
						  accommodations for any disability, and cultural framework of the beneficiary
						  and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  6
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Homeless Shelter
(04); Assisted Living Facility (13); Group Home
						  (14)
AGE GROUP(S):
Ages 18 and over
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of Service
. Start and stop times of actual group encounter that
						  includes identified beneficiary
* Place of service
* Number of participants
* Diagnosis and pertinent interval history
* Focus of group
* Brief mental status and observations
. Rationale for group intervention and intervention
						  used that must coincide with master treatment plan
* Beneficiary's response to the group intervention that
						  includes current progress or regression and prognosis
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
. If provided by physician that is not a psychiatrist,
						  then any off label uses of medications must include documented consultation
						  with the overseeing psychiatrist
. Plan for next group session, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
This service applies
						  only to medications prescribed to address targeted symptoms as identified in
						  the master treatment plan. This does NOT include
psychosocial groups
in rehabilitative day programs or educational groups. The maximum that
						  may be served in a specified group is ten (10). Providers may bill for services
						  only at times during which beneficiaries participate in this program
						  activity.
36415
HA
SERVICE: Routine Venipuncture for Collection of
						  Specimen
DEFINITION:
The process of drawing a blood
						  sample through venipuncture (i.e., inserting a needle into a vein to draw the
						  specimen with a syringe or vacutainer) or collecting a urine sample by
						  catheterization as ordered by a physician or psychiatrist.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED: 1,
Per routine
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 12
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Assisted Living
Facility (13); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of Service
* Start and stop times of the specific procedure
* Place of service (If 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis
* Brief mental status and observations
. Rationale for and procedure used that must coincide
						  with master treatment plan and physician or psychiatrist orders
* Description of procedure
. Beneficiary's response to procedure, if any
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
. Plan for follow-up services
* Staff signature/credentials/date of signature(s)
NOTES and COMMENTS:
This service may be provided only to
						  beneficiaries taking prescribed psychotropic medication or who have a substance
						  abuse diagnosis.
90887
HA
SERVICE: Collateral Intervention, Mental Health
						  Professional DEFINITION:
A face-to-face contact by a mental health
						  professional with caregivers, family members, other community-based service
						  providers or other Participants on behalf of and with the expressed written
						  consent of an identified beneficiary in order to obtain or share
90887 90887
U1 HA, UB
relevant information necessary to the enrolled
						  beneficiary's assessment,
master treatment plan , and/or rehabilitation. The
						  identified beneficiary does not have to be present for this service. Services
						  are to be congruent with the age, strengths, needed accommodations for any
						  disability, and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Patient's Home (12);
School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group
Home (14); Other Locations (99); and for ages 21 and
						  over, RSPMI
Clinic (Telemedicine) (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of Service
* Names and relationship to the beneficiary of all
						  persons involved
* Start and stop times of actual encounter with
						  collateral contact
* Place of Service (If 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis and pertinent interval history
* Rationale for and intervention used that must
						  coincide with the master treatment plan
* Collateral contact's response to intervention
* Impact of information received/given on the
						  beneficiary's treatment
* Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Plan for next contact, if any
* Staff signature/credentials/Date of signature
NOTES and COMMENTS:
The collateral
						  intervention must be identified on the master treatment plan as a medically
						  necessary service. Medicaid WILL NOT pay for incidental or happenstance
						  meetings with individuals. For example, a chance meeting with a beneficiary's
						  adult daughter at the corner store which results in a conversation regarding
						  the well-being of the beneficiary may not be billed as a collateral contact.
						  Billing for interventions performed by a mental health professional must
						  warrant the need for the higher level of staff licensure. Professional
						  interventions of a type which could be provided by a paraprofessional will
						  require documentation of the reason it was needed.
Contacts between individuals in the employment of RSPMI
						  agencies or facilities are not a billable collateral intervention.
Collateral Intervention, Mental Health
						  Professional
Apply the above description.
Additional information: 90887 plus modifier "U1" is for
						  service provided via telemedicine only.
SERVICE: Collateral Intervention, Mental Health
						  Paraprofessional DEFINITION:
A face-to-face contact by a mental health
						  paraprofessional with caregivers, family members, other community-
H2011
HA, U6
based service providers or other Participants on behalf
						  of and with the expressed written consent of an identified beneficiary in order
						  to obtain or share relevant information necessary to the enrolled beneficiary's
						  assessment, master treatment plan, and/or rehabilitation. Services are to be
						  congruent with the age, strengths, needed accommodation for any disability, and
						  cultural framework of the beneficiary and his/her family.
The identified beneficiary does not have to be present
						  for this service.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  4
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Patient's Home (12);
School (03); Homeless Shelter (04); Assisted Living
						  Facility (13); Group
Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements:
* Date of Service
* Names and relationship to the beneficiary of all
						  persons involved
* Start and stop times of actual encounter with
						  collateral contact
. Place of Service (If 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis and pertinent interval history
. Rationale for and intervention used that must
						  coincide with the master treatment plan
* Collateral contact's response to intervention
. Impact of information received/given on the
						  beneficiary's treatment
* Any changes indicated for the master treatment plan
						  which must be documented and communicated to the supervising MHP
* Plan for next contact, if any
* Staff signature/credentials/Date of signature
NOTES and COMMENTS
Supervision by a Mental
						  Health Professional must be documented in personnel files and addressed in
						  accordance of agency's policies, quality assurance procedures, personnel
						  performance evaluations, reports of supervisors, or other equivalent documented
						  method of supervision.
The collateral intervention must be identified on the
						  master treatment plan as a medically necessary service. Medicaid WILL NOT pay
						  for incidental or happenstance meetings with individuals. For example, a chance
						  meeting with a beneficiary's adult daughter at the corner store which results
						  in a conversation regarding the well-being of the beneficiary may not be billed
						  as a collateral contact. Contacts between individuals in the employment of
						  RSPMI agencies or facilities are not a billable collateral intervention.
SERVICE: Crisis Stabilization Intervention,
						  Mental Health Professional
DEFINITION:
Scheduled face-to-face
						  treatment activities provided to a beneficiary who has recently experienced a
						  psychiatric or behavioral crisis that are expected to further stabilize,
						  prevent deterioration, and serve as an alternative to 24-hour inpatient care.
						  Services are to be congruent with the age, strengths, needed accommodation for
						  any disability, and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); RSPMI Clinic (forages 21 and over)
						  (Telemedicine)
(99); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of service
. Start and stop time of actual encounter with
						  beneficiary
* Place of service, (If 99 is used, specific location
						  and rationale for location must be included)
* Diagnosis and pertinent interval history
* 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 intervention 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 . Staff signature/credentials/date of signature(s)
NOTES and COMMENTS:
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.
H2011
U2
Crisis Stabilization Intervention, Mental Health
						  Professional
Apply the above description.
Additional information: H2011 plus modifier "U2" is for
						  ages 21 and over.
H2011
HA, U5
SERVICE: Crisis Stabilization Intervention,
						  Mental Health
Paraprofessional
DEFINITION:
Scheduled face-to-face
						  treatment activities provided to a beneficiary who has recently experienced a
						  psychiatric or behavioral crisis that are expected to further stabilize,
						  prevent deterioration, and serve as an alternative to 24-hour inpatient care.
						  Services are to be congruent with the age, strengths, needed accommodation for
						  any disability, and cultural framework of the beneficiary and his/her
						  family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  12
YEARLY MAXIMUM OF UNITS THAT MAY BE BILLED
						  without
extension: 72
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of service
. Start and stop time of actual encounter with
						  beneficiary
* Place of service If 99 is used, specific location and
						  rationale for location must be included)
. Diagnosis and pertinent interval history
* Behavioral observations
* Consult with MHP or physician regarding events that
						  necessitated this service and the review of the outcome of the
						  intervention
* Intervention used must coincide with the master
						  treatment plan, psychiatric advance directive or crisis plan which must be
						  documented and communicated to the supervising MHP
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Plan for next session, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
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.
Supervision by a Mental Health Professional must be
						  documented and addressed in personnel files in accordance with the agency's
						  policies, quality assurance procedures, personnel performance evaluations,
						  reports of supervisors, or other equivalent documented method of
						  supervision.
H2011
U1
Crisis Stabilization Intervention, Mental Health
						  Paraprofessional
Apply the description above.
Additional information: H2011 plus modifier "U1" is for
						  ages 21 and over
H2015
HA, U5
SERVICE: Intervention, Mental Health Professional
						  (formerly On-
Site and Off-Site Interventions,
						  MHP)
DEFINITION:
Face-to-face medically
						  necessary treatment activities provided to a beneficiary consisting of specific
						  therapeutic interventions as prescribed on the master treatment plan to
						  re-direct a beneficiary from a psychiatric or behavioral regression or to
						  improve the beneficiary's progress toward specific goal(s) and outcomes. These
						  activities may be either scheduled or unscheduled as the goal warrants.
Services are to be congruent with the age, strengths,
						  necessary accommodations for any disability, and cultural framework of the
						  beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); RSPMI Clinic for Ages 21 and over
						  (Telemedicine)
(99); Other Locations (99)
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Start and stop times of actual encounter with
						  beneficiary . Date of service
* Place of service, (If 99 is used, specific location
						  and rationale for location must be included)
. Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and intervention used that must be
						  medically necessary
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
. Any changes indicated for the master treatment plan,
						  diagnosis, or medication(s)
* Plan for next intervention, including any homework
						  assignments
* Staff signature/credentials/date of signature(s)
NOTES and COMMENTS:
Interventions of a type that could be performed
						  by a paraprofessional may not be billed at a mental health professional rate
						  unless the medical necessity for higher level staff is clearly
						  documented.
H2015
U6
Intervention, Mental Health
						  Professional
Apply the above description.
Additional information: H2015 plus modifier "U6" is for
						  ages 21 and over.
H2015
U7
Intervention, Mental Health
						  Professional
Apply the above description.
Additional information: H2015 plus modifier "U7" is for
						  services provided via telemedicine only.
H2015
HA, U1
SERVICE: Intervention, Mental Health
						  Paraprofessional (formerly
On-Site and Off-Site Intervention, Mental Health
						  Paraprofessional)
DEFINITION:
Face-to-face, medically
						  necessary treatment activities provided to a beneficiary consisting of specific
						  therapeutic interventions prescribed on the master treatment plan, which are
						  expected to accomplish a specific goal or objective listed on the master
						  treatment plan. These activities may be either scheduled or unscheduled as the
						  goal or objective warrants. Services are to be congruent with the age,
strengths, necessary accommodations for any disability,
						  and cultural framework of the beneficiary and his/her family.
DAILY MAXIMUM OF UNITS THAT MAY BE BILLED:
						  8
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Beneficiary's Home
(12); School (03); Homeless Shelter (04); Assisted
						  Living Facility (13);
Group Home (14); Other Locations (99
AGE GROUP(S):
Ages 21 and over; U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of service
* Start and stop times of actual encounter with
						  beneficiary
. Place of service (If 99 is used, specific location
						  and rationale for
location must be included)
* Diagnosis and pertinent interval history
. Rationale for and intervention used that must
						  coincide with the master treatment plan
* Beneficiary's response to intervention that includes
						  current progress or regression and prognosis
* Plan for next intervention, including any homework
						  assignments
* Staff signature/credentials/date of
						  signature(s)
NOTES and COMMENTS:
Billing for this
						  service does not include time spent transporting the beneficiary to a required
						  service, nor does it include time spent waiting while a beneficiary attends a
						  scheduled or unscheduled appointment. Supervision by a Mental Health
						  Professional must be documented and addressed in personnel files in accordance
						  with the agency's policies, quality assurance procedures, personnel performance
						  evaluations, reports of supervisors, or other equivalent documented method of
						  supervision.
H2015
U2
Intervention, Mental Health
						  Paraprofessional
Apply the above description.
Additional information: H2015 plus modifier "U2" is for
						  ages 21 and over
H2017
HA, U1
SERVICE: U21 Rehabilitative Day Service
						  DEFINITION:
An array of face-to-face interventions providing a preplanned
						  and structured group program for identified beneficiaries that improve
						  emotional and behavioral symptoms of youth diagnosed with childhood disorders,
						  as distinguished from the symptom stabilization function of acute day
						  treatment. These interventions are person- and family-centered,
						  age-appropriate, recovery based, culturally competent, must reasonably
						  accommodate disability, and must have measurable outcomes. These activities are
						  designed to assist the beneficiary with compensating for or eliminating
						  functional deficits and interpersonal and/or environmental barriers associated
						  with their mental illness. The intent of these services is to enhance a youth's
						  functioning in the home, school, and community with the least amount of ongoing
						  professional intervention. Skills addressed may include: emotional skills, such
						  as coping with stress, anxiety, or anger; behavioral skills, such as positive
						  peer interactions, appropriate social/family interactions, and managing overt
						  expression of symptoms like impulsivity and anger; daily living and self-care
						  skills, such as personal care and hygiene, and daily structure/use of time;
						  cognitive skills, such as problem solving, developing a positive self-esteem,
						  and reframing, money management, community integration, understanding illness,
						  symptoms and the proper use of medications; and any similar skills required to
						  implement a beneficiary's master treatment plan .
DAILY MAXIMUM UNITS THAT MAY BE BILLED:
No
						  more than 16 units may be billed per day.
WEEKLY MAXIMUM OF UNITS THAT MAY BE BILLED:
80 for ages up to 18; 120 forages 18-20.
PRIOR AUTHORIZATION
						  REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  School (03); Assisted Living Facility (13); Group Home (14)
MAXIMUM PARAPROFESSIONAL STAFF to CLIENT RATIOS:
1:10
ratio maximum with the provision that client ratio must
						  be reduced when necessary to accommodate significant issues related to
						  acuity,
developmental status and clinical needs.
AGEGROUP(S):
U21
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Start and stop times of actual program participation
						  by beneficiary
* Date of service
* Place of service
. Diagnosis and pertinent interval history
* Brief mental status and observations
* Rationale for and interventions used that must
						  coincide with the master treatment plan
* Beneficiary's response to the intervention that
						  includes current progress or lack of progress toward functional improvement and
						  attainment of goals
. Rationale for continued rehabilitative day
						  service
* Staff signature/credentials
* Supervising staff signature/credentials/date of
						  signature(s)
. a weekly summary describing therapeutic activities
						  provided and the beneficiary's progress or lack of progress in achieving the
						  treatment goal(s) and established outcomes to be accomplished
NOTES and
						  COMMENTS:
Providers may bill for services only at times during which
						  beneficiaries participate in program activities, Providers are expected to sign
						  patients in and out of the program to provide medically necessary treatment
						  therapies. However, in order to be claimed separately, these therapies must be
						  identified on the Master Treatment Plan and serve a treatment purpose which
						  cannot be accomplished within the day treatment setting.
H2017
SERVICE: Adult Rehabilitative Day Service
						  DEFINITION:
An array of face-to-face interventions providing a preplanned
						  and structured group program for identified beneficiaries that aimed at
						  long-term recovery and maximization of self-sufficiency, as distinguished from
						  the symptom stabilization function of acute day treatment. These interventions
						  are person- and family-centered, recovery based, culturally competent, provide
						  needed accommodation for any disability and must have measurable outcomes.
						  These activities assist the beneficiary with compensating for or eliminating
						  functional deficits and interpersonal and/or environmental barriers associated
						  with their chronic mental illness. The intent of these services is to restore
						  the fullest possible integration of the beneficiary as an active and productive
						  member of his/her family, social and work community and/or culture with the
						  least amount of ongoing professional intervention. Skills addressed may
						  include: emotional skills, such as coping with stress, anxiety, or anger;
						  behavioral skills, such as proper use of medications, appropriate social
						  interactions, and managing overt expression of symptoms like delusions or
						  hallucinations; daily living and self-care skills, such as personal care and
						  hygiene, money management, and daily structure/use of time; cognitive skills,
						  such as problem solving, understanding illness
and symptoms, and reframing; community integration
						  skills and any similar skills required to implement a beneficiary's master
						  treatment plan
DAILY MAXIMUM UNITS THAT MAY BE BILLED:
						  24
WEEKLY MAXIMUM OF UNITS THAT MAY BE BILLED:
120
PRIOR AUTHORIZATION REQUIRED
ALLOWABLE PLACES OF SERVICE:
Office (11);
						  Assisted Living
Facility (13); Group Home (14)
MAXIMUM PARAPROFESSIONAL STAFF to CLIENT RATIOS:
1:15
ratio maximum with the provision that client ratio must
						  be reduced when necessary to accommodate significant issues related to
						  acuity,
developmental status and clinical needs.
AGE GROUP(S):
Ages 21 and over
DOCUMENTATION REQUIREMENTS (See Section
						  226.200 for
additional requirements):
* Date of service
* Start and stop times of actual program participation
						  by beneficiary
. Place of service
* Diagnosis and pertinent interval history
* Brief mental status and observations
. Rationale for and interventions used that must
						  coincide with the master treatment plan
* Beneficiary's response to the intervention that
						  includes current progress or lack of progress toward functional improvement and
						  attainment of goals
* Rationale for continued rehabilitative day
						  service
* Staff signature/credentials
* Supervising staff signature/credentials/date of
						  signature(s)
* a weekly summary describing therapeutic activities
						  provided and the beneficiary's progress or lack of progress in achieving the
						  treatment goal(s) and established outcomes to be accomplished through
						  participation in rehabilitative day service.
NOTES and COMMENTS:
Rehabilitative Day
						  services do NOT include vocational services and training, academic education,
						  personal care or home health services, purely recreational activities and may
						  NOT be used to supplant services which may be obtained or are required to be
						  provided by other means. Providers may bill for services only at times during
						  which beneficiaries participate in program activities, Providers are expected
						  to sign patients in and out of the program to provide medically necessary
						  treatment therapies. However, in order to be claimed separately, these
						  therapies must be identified on the Master Treatment Plan and serve a treatment
						  purpose which cannot be accomplished within the day treatment setting.
252.200
Place of Service Codes
Electronic and paper claims now require the same national place
				of service codes.
Place of Service
POS Codes
Outpatient Hospital
22
Office (RSPMI Facility Service Site)
11
Patient's Home
12
Nursing Facility
32
Skilled Nursing Facility
31
School (Including Licensed Child Care
03
Facility)
Homeless Shelter
04
Assisted Living Facility (Including Residential
13
Care Facility)
Group Home
14
ICF/MR
54
Other Locations
99
RSPMI Clinic (Telemedicine)
99
Emergency Services in ER
23
252.430
Daily Service Billing
			 Exclusions
RSPMI providers may not bill for the following services
				together on the same date of service:
National Codes and Modifiers
Service Titles
90885 -HA, U2
AND
90885 - HA or
90885-HA, U1
Master treatment plan and Periodic Review of Master
						  treatment plan
H2017-HA, U1 AND
Adult Rehabilitative Day Service AND
H2017
U21 Rehabilitative Day Service
90801 or90801-HA, U1 AND
Mental Health Evaluation/Diagnosis AND
90885-HA, or 90885 HA, U1
Periodic Review of Master treatment plan
90862 or 90862-HA or 90862-HA, UB AND 90862-HA,
						  HQ
Pharmacologic Management
AND
Group Outpatient - Pharmacologic Management by a
						  Physician
H2012-HAorH2012-
UA
AND
H2017
Therapeutic Day/Acute Day
AND
Adult Rehabilitative Day Service
H2012-HAorH2012-
UA
AND
H2017-HA, U1
Therapeutic Day/Acute Day
AND
U21 Rehabilitative Day Service
99201-HA.UB; 99202-HA, UB; 99203-HA, UB; 99204-HA, UB;
						  99211-HA, UB; 99212-HA, UB; 99213-HA, UB; 99214-HA.UB; 99201-HA.SA; 99202-HA,
						  SA; 99203-HA, SA; 99204-HA, SA; 99211-HA, SA; 99212 -HA, SA; 99213-HA, SA;
						  99214 - HA, SA; AND
90862 or 90862-HA or 90862-HA, UB
Physical Examination
AND
Pharmacologic Management
99201-HA.UB; 99202-HA, UB; 99203-HA, UB; 99204-HA, UB;
						  99211-HA, UB; 99212-HA, UB; 99213-HA, UB; 99214-HA.UB; 99201-HA.SA; 99202-HA,
						  SA; 99203-HA, SA; 99204-HA, SA; 99211-HA, SA; 99212 -HA, SA; 99213-HA, SA;
						  99214 - HA, SA; AND 90862-HA, HQ
Physical Examination
AND
Group Outpatient - Pharmacologic Management by a
						  Physician
AMOUNT, DURATION AND SCOPE OF SERVICES
				PROVIDED
ATTACHMENT 3.1-A
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
a. Diagnostic services - Not
			 Provided.
b. Screening services -
			 Not Provided.
c. Preventive
			 services - Not Provided.
d.
			 Rehabilitative Services
1. Rehabilitative
			 Services for Persons with Mental Illness (RSPMI)
A comprehensive system of care for behavioral health
				services has been developed for use by RSPMI providers. The changes to the
				program were developed in coordination with providers, representatives of the
				Arkansas System of Care and other key stakeholders.
DMS is seeking first to revise service definitions and
				methods within this program to meet the needs of persons whose illnesses meet
				the definitions outlined in the American Psychiatric Association Diagnostic and
				Statistical Manual. Revised methods did not affect rates. No services were
				added therefore there is not a fiscal impact.
A.
Scope
A range of mental health rehabilitative or palliative
				services is provided by a duly certified RSPMI provider to Medicaid-eligible
				beneficiaries suffering from mental illness, as described in the American
				Psychiatric Association Diagnostic and Statistical Manual (DSM-IV and
				subsequent revisions).
DMS has set forth in policy the settings in which each
				individual service may be provided. Each service shown below includes the place
				of service allowable for that procedure.
Services:
* SERVICE: Speech Evaluation
DEFINITION: Evaluation for Speech Therapy defined by
				applicable state and federal rules and regulations.
This service must be performed by
a
professional as described in the Physical, Occupational, and Speech Therapy
				Program provider
manual
* SERVICE: Mental Health
				Evaluation/Diagnosis
DEFINITION: The cultural, developmental, age and
				disability -relevant clinical evaluation and determination of a beneficiary's
				mental status; functioning in various life domains; and an axis five DSM
				diagnostic Coverage authority for these mental health rehabilitative services
				expires on September 1,2010.
13. Other diagnostic, screening,
			 preventive and rehabilitative services, i.e., other than those provided
			 elsewhere in this plan.
d. Rehabilitative
			 Services formulation for the purpose of developing a plan of care. This service
			 is required prior to provision of all other mental health services with the
			 exception of crisis interventions. Services are to be congruent with the age,
			 strengths, necessary, accommodations for disability, and cultural framework of
			 the beneficiary and his/her family.
Setting information could be summarized in the description if
				the State would like to include this information.
This service must be performed by a physician or mental
				health professional and is necessary to determine how best to proceed in
				developing an array of rehabilitative treatment services for maximum reduction
				of a mental disability and to restore the beneficiary to his or her best
				possible functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Psychological Evaluation
DEFINITION: A Psychological Evaluation employs standardized
				psychological tests conducted and documented for evaluation, diagnostic, or
				therapeutic purposes. The evaluation must be medically necessary, culturally
				relevant; with reasonable accommodations for any disability, provide
				information relevant to the beneficiary's continuation in treatment, and assist
				in treatment planning. All psychometric instruments must be administered,
				scored, and interpreted by the qualified professional.
This service must be performed by a physician or mental
				health professional and is necessary to determine how best to proceed in
				developing an array of rehabilitative treatment services for maximum reduction
				of a mental disability and to restore the beneficiary to his or her best
				possible functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Psychiatric Diagnostic Assessment
DEFINITION: A direct face-to-face service contact occurring
				between the physician and the beneficiary for the purpose of evaluation.
				Psychiatric Diagnostic Assessment includes a history, mental status, and a
				disposition, and may include communication with family or other sources,
				ordering and medical interpretation of laboratory or other medical diagnostic
				studies. (See Section
				224.000 for additional
				requirements.)
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed by a physician and is
				necessary to determine how best to proceed in developing an array of
				rehabilitative treatment services for maximum reduction of a mental disability
				and to restore the beneficiary to his or her best possible functional
				level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Master Treatment Plan
DEFINITION: A developed plan in cooperation with the
				beneficiary (parent or guardian if the beneficiary is under 18), to deliver
				specific mental health services to the beneficiary to restore, improve or
				stabilize the beneficiary's mental health condition. The plan must be based on
				individualized service needs identified in the completed Mental Health
				Diagnostic Evaluation. The plan must include goals for the medically necessary
				treatment of identified problems, symptoms and mental health conditions. The
				plan must identify individuals or treatment teams responsible for treatment,
				specific treatment modalities prescribed for the beneficiary, time limitations
				for services, and documentation of medical necessity by the supervising
				physician.
This service must be performed by a physician and
				licensed mental health professionals in conjunction with the beneficiary and is
				necessary for developing an array of rehabilitative treatment services
				according to goals and objectives for maximum reduction of a mental disability
				and to restore the beneficiary to his or her best possible functional
				level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Periodic Review of Master Treatment Plan DEFINITION:
				The periodic review and revision of the master treatment plan, in cooperation
				with the beneficiary, to determine the beneficiary's progress or lack of
				progress toward the master treatment plan goals and objectives; the efficacy of
				the services provided; and continued medical necessity of services. This
				includes a review and revision of the measurable goals and measurable
				objectives directed at the medically necessary treatment of identified
				symptoms/mental health condition, individuals or treatment teams responsible
				for treatment, specific treatment modalities, and necessary accommodations that
				will be provided to the beneficiary, time limitations for services, and the
				medical necessity of continued
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
services. Services are to be congruent with the age, strengths,
				necessary accommodations for any disability, and cultural framework of the
				beneficiary and his/her family.
This service must be performed by a physician and
				licensed mental health professionals in conjunction with the beneficiary to
				ensure that the array of rehabilitative treatment services is producing the
				desired outcome according to goals and objectives and to determine if the
				maximum reduction of a mental disability restoration of the beneficiary to his
				or her best possible functional level is progressing.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Interpretation of Diagnosis
DEFINITION: A face-to face therapeutic intervention provided to
				a beneficiary in which the results/implications/diagnoses from a mental health
				diagnosis evaluation or a psychological evaluation are explained by the
				professional who administered the evaluation. Services are to be congruent with
				the age, strengths, necessary accommodations, and cultural framework of the
				beneficiary and his/her family.
This service must be performed by a physician or
				licensed mental health professional to assist the beneficiary and his or her
				primary support persons in understanding what is necessary for developing an
				array of rehabilitative treatment services for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Individual Psychotherapy
DEFINITION: Face-to-face treatment provided by a licensed
				mental health professional on an individual basis. Services consist of
				structured sessions that work toward achieving mutually defined goals as
				documented in the master treatment plan. Services are to be congruent with the
				age, strengths, needed accommodations necessary for any disability, and
				cultural framework of the beneficiary and his/her family. The treatment service
				must reduce or alleviate identified symptoms, maintain or improve level of
				functioning, or prevent deterioration.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Marital/Family Psychotherapy - Beneficiary is not
				present DEFINITION: Face-to-face treatment provided to more than one member of
				a family simultaneously in the same session or treatment with an individual
				family member (i.e. Spouse or Single Parent) that is specifically related to
				achieving goals identified on the beneficiary's master treatment plan. The
				identified beneficiary is not present for this service. Services are to be
				congruent with the age, strengths, needed accommodations for any disability,
				and cultural framework of the beneficiary and his/her family. These services
				identify and address marital/family dynamics and improve/strengthen
				marital/family interactions and functioning in relationship to the beneficiary,
				the beneficiary's condition and the condition's impact on the marital/family
				relationship.
When all three conditions are taken together, it would be
				necessary to address marital/family dynamics and improve/strengthen the
				marital/family interactions and functioning in order o focus on the Medicaid
				eligible beneficiary's condition and how it can be improved.
The reason for providing this service is to improve the
				integrity of the patient's support system and documentation must reflect how
				the therapy accomplishes that rather than becoming therapy for the caregiver in
				and of itself.
The service may only be provided by a mental health
				professional practicing within the scope of their licensure.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Marital/Family Psychotherapy - Beneficiary is
				present DEFINITION: Face-to-face treatment provided to more than one member of
				a family simultaneously in the same session or treatment with an individual
				family member (i.e. Spouse or Single Parent) that is specifically related to
				achieving goals identified on the beneficiary's master treatment plan. The
				identified beneficiary must be present for this service. Services are to be
				congruent with the age, strengths, needed accommodations for disability, and
				cultural framework of the beneficiary and his/her family. These services are to
				be utilized to identify and address marital/family dynamics and
				improve/strengthen marital/family interactions and functioning in relationship
				to the beneficiary, the beneficiary's condition and the condition's impact on
				the marital/family relationship.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
*
Individual Outpatient - Speech Therapy,
				Speech Language Pathologist Scheduled individual outpatient care provided by a
				licensed speech pathologist supervised by a physician to a Medicaid-eligible
				beneficiary for the purpose of treatment and remediation of a communicative
				disorder deemed medically necessary. See the Occupational, Physical and Speech
				Therapy Program Provider Manual for specifics of the speech therapy
				services.
This service must be performed by licensed speech
				language pathologist and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* Individual Outpatient - Speech Therapy, Speech Language
				Pathologist Assistant
Scheduled individual outpatient care provided by a licensed
				speech pathologist assistant supervised by a qualified speech language
				pathologist to a Medicaid-eligible beneficiary for the purpose of treatment and
				remediation of a communicative disorder deemed medically necessary. See the
				Occupational, Physical and Speech Therapy Program Provider Manual for specifics
				of the speech therapy services.
This service must be performed by licensed speech
				language pathologist assistant and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* Group Outpatient - Speech Therapy, Speech Language
				Pathologist Contact between a group of Medicaid-eligible beneficiaries and a
				speech pathologist for the purpose of speech therapy and remediation. See the
				Occupational, Physical and Speech Therapy Provider Manual for specifics of the
				speech therapy services.
Group Outpatient - Speech Therapy, Speech Language Pathologist
				Assistant
Contact between a group of Medicaid-eligible beneficiaries and
				a speech pathologist assistant for the purpose of speech therapy and
				remediation. See the Occupational, Physical and Speech Therapy Provider Manual
				for specifics of the speech therapy services.
This service must be performed by licensed speech
				language pathologist and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
*
SERVICE: Group Outpatient - Group
				Psychotherapy DEFINITION: Face-to-face interventions provided to a group of
				beneficiaries on a regularly scheduled basis to improve behavioral or cognitive
				problems which either cause or exacerbate mental illness.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
The professional uses the emotional interactions of the group's
				members to assist them in implementing each beneficiary's master treatment
				plan. Services are to be congruent with the age, strengths, needed
				accommodation for any disability, and cultural framework of the beneficiary and
				his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Therapeutic Day/Acute Day Treatment
DEFINITION: This service includes the administration of
				individual, family/marital and group therapies, face to face interventions and
				supportive services and is designed to be more intensive in nature than
				rehabilitative day services.
The providers are a combination of licensed professionals
				(psychologist, LCSW, LPC, LPE, RN, and paraprofessionals. Licensed
				professionals must supervise the milieu and a physician must provide oversight.
				Paraprofessionals must be supervised by a licensed professional.
Short-term daily array of continuous, highly structured,
				intensive outpatient services provided by a mental health professional. These
				services are for beneficiaries experiencing acute psychiatric symptoms that may
				result in the beneficiary being in imminent danger of psychiatric
				hospitalization and are designed to stabilize the acute symptoms. These direct
				therapy and medical services are intended to be an alternative to inpatient
				psychiatric care and are expected to reasonably improve or maintain the
				beneficiary's condition and functional level to prevent hospitalization and
				assist with assimilation to his/her community after an inpatient psychiatric
				stay of any length. These services are to be provided by a team consisting of
				mental health clinicians, paraprofessionals and nurses, with physician
				oversight and availability. The team composition may vary depending on clinical
				and programmatic needs but must at a minimum include a licensed mental health
				clinician and physician who provide services and oversight. Services are to be
				congruent with the age,
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
strengths, needed accommodation for any disability, and
				cultural framework of the beneficiary and his/her family.
These services must include constant staff supervision of
				beneficiaries and physician oversight.
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Crisis Intervention
DEFINITION: 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.)
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
*
SERVICE: Physical Examination - Psychiatrist
				or Physician Physical Examination - Psychiatric Mental Health Clinical Nurse
				Specialist or Psychiatric Mental Health Advanced Nurse Practitioner
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
DEFINITION: A general multisystem examination based on age and
				risk factors to determine the state of health of an enrolled RSPMI
				beneficiary.
This service must be performed by a psychiatrist,
				physician, psychiatric mental health clinical nurse specialist or psychiatric
				mental health advanced nurse practitioner and is necessary as part of an array
				of other rehabilitative treatment services used together when clinically
				indicated according to a master treatment plan for maximum reduction of a
				mental disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Pharmacologic Management by Physician (formerly
				Medication Maintenance by a physician)
Pharmacologic Management by Mental Health Clinical Nurse
				Specialist or Psychiatric Mental Health Advanced Nurse Practitioner DEFINITION:
				Provision of service tailored to reduce, stabilize or eliminate psychiatric
				symptoms by addressing individual goals in the master treatment plan. 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, necessary accommodations for any disability, and cultural framework
				of the beneficiary and his/her family.
This service must be performed by a psychiatrist,
				physician, psychiatric mental health clinical nurse specialist or psychiatric
				mental health advanced nurse practitioner and is necessary as part of an array
				of other rehabilitative treatment services used together when clinically
				indicated according to a master treatment plan for maximum reduction of a
				mental disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* SERVICE: Medication Administration by a Licensed Nurse
				DEFINITION: Administration of a physician-prescribed medication to a
				beneficiary. This includes preparing the beneficiary and medication; actual
				administration of oral, intramuscular and/or subcutaneous medication;
				observation of the beneficiary after administration and any possible adverse
				reactions; and returning the medication to its previous storage.
This service must be performed by a qualified, licensed
				health care professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Group Outpatient - Pharmacologic Management by a
				Physician
DEFINITION: Therapeutic intervention provided to a group of
				beneficiaries by a licensed physician involving evaluation and maintenance of
				the Medicaid-eligible beneficiary on a medication regimen with simultaneous
				supportive psychotherapy in a group setting. This includes evaluating
				medication prescription, administration, monitoring, and supervision; and
				informing beneficiaries regarding medication(s) and its potential effects and
				side effects. Services are to be congruent with the age, strengths, necessary
				accommodations for any disability, and cultural framework of the beneficiary
				and his/her family.
This service must be performed by a physician and is
				necessary as part of an array of other rehabilitative treatment services used
				together when clinically indicated according to a master treatment plan for
				maximum reduction of a mental disability and to restore the beneficiary to his
				or her best possible functional level
Please refer to Provider Qualifications on page
				6al8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* SERVICE: Routine Venipuncture for Collection of Specimen
				DEFINITION: The process of drawing a blood sample through venipuncture (i.e.,
				inserting a needle into a vein to draw the specimen with a syringe or
				vacutainer) or collecting a urine sample by catheterization as ordered by a
				physician or psychiatrist.
This service must be performed by a qualified, licensed
				health care professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Collateral Intervention, Mental Health Professional
				DEFINITION: A face-to-face contact by a mental health professional with
				caregivers, family members, other community-based service providers or other
				Participants on behalf of and with the expressed written consent of an
				identified beneficiary in order to obtain or share relevant information
				necessary to the enrolled beneficiary's assessment, master treatment plan ,
				and/or rehabilitation. The identified beneficiary does not have to be present
				for this service. Services are to be congruent with the age, strengths, needed
				accommodations for any disability, and cultural framework of the beneficiary
				and his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
*
SERVICE: Collateral Intervention, Mental
				Health Paraprofessional DEFINITION: A face-to-face contact by a mental health
				paraprofessional with caregivers, family members, other community-based service
				providers or other Participants on behalf of and with the expressed written
				consent of an identified beneficiary in order to obtain
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
or share relevant information necessary to the enrolled
				beneficiary's assessment, master treatment plan, and/or rehabilitation.
				Services are to be congruent with the age, strengths, needed accommodation for
				any disability, and cultural framework of the beneficiary and his/her family.
				The identified beneficiary does not have to be present for this service.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Crisis Stabilization Intervention, Mental Health
				Professional
DEFINITION: Scheduled face-to-face treatment activities
				provided to a beneficiary who has recently experienced a psychiatric or
				behavioral crisis that are expected to further stabilize, prevent
				deterioration, and serve as an alternative to 24-hour inpatient care. Services
				are to be congruent with the age, strengths, needed accommodation for any
				disability, and cultural framework of the beneficiary and his/her
				family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Crisis Stabilization Intervention, Mental Health
				Paraprofessional
DEFINITION: Scheduled face-to-face treatment activities
				provided to a beneficiary who has recently experienced a psychiatric or
				behavioral crisis that are expected to further stabilize, prevent
				deterioration, and serve as an alternative to 24-hour inpatient care. Services
				are to be
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
congruent with the age, strengths, needed accommodation for any
				disability, and cultural framework of the beneficiary and his/her
				family.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Intervention, Mental Health Professional (formerly
				On-Site and Off-Site Interventions, MHP)
DEFINITION: Face-to-face medically necessary treatment
				activities provided to a beneficiary consisting of specific therapeutic
				interventions as prescribed on the master treatment plan to re-direct a
				beneficiary from a psychiatric or behavioral regression or to improve the
				beneficiary's progress toward specific goal(s) and outcomes. These activities
				may be either scheduled or unscheduled as the goal warrants. Services are to be
				congruent with the age, strengths, necessary accommodations for any disability,
				and cultural framework of the beneficiary and his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Intervention, Mental Health Paraprofessional
				(formerly On-Site and Off-Site Intervention, Mental Health Paraprofessional)
				DEFINITION: Face-to-face, medically necessary treatment activities provided to
				a beneficiary consisting of specific therapeutic interventions prescribed on
				the master treatment plan, which are expected to accomplish a specific goal or
				objective listed on the master
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
treatment plan. These activities may be either scheduled
				or unscheduled as the goal or objective warrants. Services are to be congruent
				with the age, strengths, necessary accommodations for any disability, and
				cultural framework of the beneficiary and his/her family.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				6al8.
* SERVICE: Rehabilitative Day Service for Persons under
				Age 18 DEFINITION: An array of face-to-face interventions providing a
				preplanned and structured group program for identified beneficiaries that
				improve emotional and behavioral symptoms of youth diagnosed with childhood
				disorders, as distinguished from the symptom stabilization function of acute
				day treatment. These interventions are person- and family-centered,
				age-appropriate, recovery based, culturally competent, must reasonably
				accommodate disability, and must have measurable outcomes. These activities are
				designed to assist the beneficiary with compensating for or eliminating
				functional deficits and interpersonal and/or environmental barriers associated
				with their mental illness. The intent of these services is to enhance a youth's
				functioning in the home, school, and community with the least amount of ongoing
				professional intervention. Skills addressed may include: emotional skills, such
				as coping with stress, anxiety, or anger; behavioral skills, such as positive
				peer interactions, appropriate social/family interactions, and managing overt
				expression of symptoms like impulsivity and anger; daily living and self-care
				skills, such as personal care and hygiene, and daily structure/use of time;
				cognitive skills, such as problem solving, developing a positive self-esteem,
				and reframing, money management, community integration, understanding illness,
				symptoms and the proper use of medications; and any similar skills required to
				implement a beneficiary's master treatment plan.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				6al8.
* Rehabilitative Day Service for Persons Ages 18-20
Apply the above definition and requirements (except Staff to
				Client Ratios, which are outlined below).
Additional information: Use code H2017 with no modifier to
				claim for services provided to beneficiaries for ages 18-20.
* SERVICE: Adult Rehabilitative Day Service
DEFINITION: Adult Rehabilitative day services provide a
				continuing, organized program of rehabilitative, therapeutic and supportive
				health services, and supervision to individuals who are mentally ill and who,
				due to the severity of their impairment, are in need of face to face
				interventions provided in a structured group program. This service is designed
				for long-term recovery and self-sufficiency.
Adult Rehabilitative day services provide rehabilitative and
				health services directed toward meeting the health restoration and maintenance
				needs of the beneficiary in a facility-based program providing specialized
				rehabilitation.
Services may include:
A. Goal compliance,
B. Problem solving,
C. Patient Safety
D. Task completion
E. Pharmaceutical supervision
			 and/or
G. Health monitoring.
			 Coverage authority for these mental health rehabilitative services expires on
			 September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
An array of face-to-face interventions providing a preplanned
				and structured group program for identified beneficiaries that aimed at
				long-term recovery and maximization of self-sufficiency, as distinguished from
				the symptom stabilization function of acute day treatment. These interventions
				are person- and family-centered, recovery based, culturally competent, provide
				needed accommodation for any disability and must have measurable outcomes.
				These activities assist the beneficiary with compensating for or eliminating
				functional deficits and interpersonal and/or environmental barriers associated
				with their chronic mental illness. The intent of these services is to restore
				the fullest possible integration of the beneficiary as an active and productive
				member of his/her family, social and work community and/or culture with the
				least amount of ongoing professional intervention. Skills addressed may
				include: emotional skills, such as coping with stress, anxiety, or anger;
				behavioral skills, such as proper use of medications, appropriate social
				interactions, and managing overt expression of symptoms like delusions or
				hallucinations; daily living and self-care skills, such as personal care and
				hygiene, money management, and daily structure/use of time; cognitive skills,
				such as problem solving, understanding illness and symptoms, and refraining;
				community integration skills and any similar skills required to implement a
				beneficiary's master treatment plan.
This service also includes the administration of individual
				intervention services, individual therapy, group therapy and supportive
				services, but are designed to assist with beneficiary functioning on a day to
				day basis within the community.
The providers are licensed mental health professionals and
				paraprofessionals under their supervision.
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				6al8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
B. Provider Qualifications
Rehabilitative Services for Persons with Mental Illness (RSPMI)
				are limited to certified providers who offer core mental health services for
				the treatment and prevention of mental disorders. The provider must be
				certified as an RSPMI provider by the Division of Behavioral Health Services.
				Providers not certified by the Division of Behavioral Health Services may not
				provide these services.
Providers for each specific RSPMI service, as detailed in the
				scope of the program section, must practice within the scope of their Arkansas
				licensure. Individuals providing RSPMI services must be:
1. Licensed in the State of Arkansas as a
			 mental health professional as defined in the RSPMI provider manual;
2. Medical records librarian as defined in
			 the RSPMI provider manual;
3.
			 Licensed in the State of Arkansas as a Psychiatrist - The psychiatrist may
			 provide oversight, medical care, or both. If the psychiatrist does not provide
			 all medically necessary RSPMI medical care, then a medical doctor may provide
			 medical care in addition to a psychiatrist;
4. Licensed Psychologist or Licensed
			 Psychological Examiner
5. Licensed
			 Physician or
6. Certified Mental
			 Health Paraprofessional, under the direct supervision of a Licensed Mental
			 Health Professional
See Section
				213.000 of the RSPMI provider
				manual for additional provider qualifications.
Qualified professionals must be present to furnish all
				medically necessary RSPMI services, including all services in each patient's
				care plan.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening,
			 preventive and rehabilitative services, i.e., other than those provided
			 elsewhere in this plan.
a. Diagnostic
			 services - Not Provided.
b.
			 Screening services - Not Provided.
c. Preventive services - Not
			 Provided.
d. Rehabilitative
			 Services
1. Rehabilitative Services for
			 Persons with Mental Illness (RSPMI)
A comprehensive system of care for behavioral health
				services has been developed for use by RSPMI providers. The changes to the
				program were developed in coordination with providers, representatives of the
				Arkansas System of Care and other key stakeholders.
DMS is seeking first to revise service definitions and
				methods within this program to meet the needs of persons whose illnesses meet
				the definitions outlined in the American Psychiatric Association Diagnostic and
				Statistical Manual. Revised methods did not affect rates. No services were
				added therefore there is not a fiscal impact.
A.
Scope
A range of mental health rehabilitative or palliative
				services is provided by a duly certified RSPMI provider to Medicaid-eligible
				beneficiaries suffering from mental illness, as described in the American
				Psychiatric Association Diagnostic and Statistical Manual (DSM-IV and
				subsequent revisions).
DMS has set forth in policy the settings in which each
				individual service may be provided. Each service shown below includes the place
				of service allowable for that procedure.
Services:
* SERVICE: Speech Evaluation
DEFINITION: Evaluation for Speech Therapy defined by
				applicable state and federal rules and regulations.
This service must be performed by
a
professional as described in the Physical, Occupational, and Speech
				Therapy Program provider
manual
SERVICE: Mental Health Evaluation/Diagnosis
DEFINITION: The cultural, developmental, age and
				disability -relevant clinical evaluation and determination of a beneficiary's
				mental status; functioning in various life domains; and an axis five DSM
				diagnostic
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic,
			 screening, preventive and rehabilitative services, i.e., other than those
			 provided elsewhere in this plan.
d.
			 Rehabilitative Services
formulation for the purpose of developing a plan of care. This
				service is required prior to provision of all other mental health services with
				the exception of crisis interventions. Services are to be congruent with the
				age, strengths, necessary, accommodations for disability, and cultural
				framework of the beneficiary and his/her family.
Setting information could be summarized in the description if
				the State would like to include this information.
This service must be performed by a physician or mental
				health professional and is necessary to determine how best to proceed in
				developing an array of rehabilitative treatment services for maximum reduction
				of a mental disability and to restore the beneficiary to his or her best
				possible functional level.
page 5dl8. Please refer to Provider Qualifications on
				page 5dl9.
* SERVICE: Psychological Evaluation
DEFINITION: A Psychological Evaluation employs standardized
				psychological tests conducted and documented for evaluation, diagnostic, or
				therapeutic purposes. The evaluation must be medically necessary, culturally
				relevant; with reasonable accommodations for any disability, provide
				information relevant to the beneficiary's continuation in treatment, and assist
				in treatment planning. All psychometric instruments must be administered,
				scored, and interpreted by the qualified professional.
This service must be performed by a physician or mental
				health professional and is necessary to determine how best to proceed in
				developing an array of rehabilitative treatment services for maximum reduction
				of a mental disability and to restore the beneficiary to his or her best
				possible functional level.
page 5dl8. Please refer to Provider Qualifications on
				page 5dl9.
* SERVICE: Psychiatric Diagnostic Assessment
DEFINITION: A direct face-to-face service contact occurring
				between the physician and the beneficiary for the purpose of evaluation.
				Psychiatric Diagnostic Assessment includes a history, mental status, and a
				disposition, and may include communication with family or other sources,
				ordering and medical interpretation of laboratory or other medical diagnostic
				studies. (See Section
				224.000 for additional
				requirements.)
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed by a physician and is
				necessary to determine how best to proceed in developing an array of
				rehabilitative treatment services for maximum reduction of a mental disability
				and to restore the beneficiary to his or her best possible functional
				level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Master Treatment Plan
DEFINITION: A developed plan in cooperation with the
				beneficiary (parent or guardian if the beneficiary is under 18), to deliver
				specific mental health services to the beneficiary to restore, improve or
				stabilize the beneficiary's mental health condition. The plan must be based on
				individualized service needs identified in the completed Mental Health
				Diagnostic Evaluation. The plan must include goals for the medically necessary
				treatment of identified problems, symptoms and mental health conditions. The
				plan must identify individuals or treatment teams responsible for treatment,
				specific treatment modalities prescribed for the beneficiary, time limitations
				for services, and documentation of medical necessity by the supervising
				physician.
This service must be performed by a physician and
				licensed mental health professionals in conjunction with the beneficiary and is
				necessary for developing an array of rehabilitative treatment services
				according to goals and objectives for maximum reduction of a mental disability
				and to restore the beneficiary to his or her best possible functional
				level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Periodic Review of Master Treatment Plan DEFINITION:
				The periodic review and revision of the master treatment plan, in cooperation
				with the beneficiary, to determine the beneficiary's progress or lack of
				progress toward the master treatment plan goals and objectives; the efficacy of
				the services provided; and continued medical necessity of services. This
				includes a review and revision of the measurable goals and measurable
				objectives directed at the medically necessary treatment of identified
				symptoms/mental health condition, individuals or treatment teams responsible
				for treatment, specific treatment modalities, and necessary accommodations that
				will be provided to the beneficiary, time limitations for services, and the
				medical necessity of continued
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
services. Services are to be congruent with the age, strengths,
				necessary accommodations for any disability, and cultural framework of the
				beneficiary and his/her family.
This service must be performed by a physician and
				licensed mental health professionals in conjunction with the beneficiary to
				ensure that the array of rehabilitative treatment services is producing the
				desired outcome according to goals and objectives and to determine if the
				maximum reduction of a mental disability restoration of the beneficiary to his
				or her best possible functional level is progressing.
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Interpretation of Diagnosis
DEFINITION: A face-to face therapeutic intervention provided to
				a beneficiary in which the results/implications/diagnoses from a mental health
				diagnosis evaluation or a psychological evaluation are explained by the
				professional who administered the evaluation. Services are to be congruent with
				the age, strengths, necessary accommodations, and cultural framework of the
				beneficiary and his/her family.
This service must be performed by a physician or
				licensed mental health professional to assist the beneficiary and his or her
				primary support persons in understanding what is necessary for developing an
				array of rehabilitative treatment services for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Individual Psychotherapy
DEFINITION: Face-to-face treatment provided by a licensed
				mental health professional on an individual basis. Services consist of
				structured sessions that work toward achieving mutually defined goals as
				documented in the master treatment plan. Services are to be congruent with the
				age, strengths, needed accommodations necessary for any disability, and
				cultural framework of the beneficiary and his/her family. The treatment service
				must reduce or alleviate identified symptoms, maintain or improve level of
				functioning, or prevent deterioration.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Marital/Family Psychotherapy - Beneficiary is not
				present DEFINITION: Face-to-face treatment provided to more than one member of
				a family simultaneously in the same session or treatment with an individual
				family member (i.e. Spouse or Single Parent) that is specifically related to
				achieving goals identified on the beneficiary's master treatment plan. The
				identified beneficiary is not present for this service. Services are to be
				congruent with the age, strengths, needed accommodations for any disability,
				and cultural framework of the beneficiary and his/her family. These services
				identify and address marital/family dynamics and improve/strengthen
				marital/family interactions and functioning in relationship to the beneficiary,
				the beneficiary's condition and the condition's impact on the marital/family
				relationship.
When all three conditions are taken together, it would be
				necessary to address marital/family dynamics and improve/strengthen the
				marital/family interactions and functioning in order o focus on the Medicaid
				eligible beneficiary's condition and how it can be improved.
The reason for providing this service is to improve the
				integrity of the patient's support system and documentation must reflect how
				the therapy accomplishes that rather than becoming therapy for the caregiver in
				and of itself.
The service may only be provided by a mental health
				professional practicing within the scope of their licensure.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Marital/Family Psychotherapy - Beneficiary is
				present DEFINITION: Face-to-face treatment provided to more than one member of
				a family simultaneously in the same session or treatment with an individual
				family member (i.e. Spouse or Single Parent) that is specifically related to
				achieving goals identified on the beneficiary's master treatment plan. The
				identified beneficiary must be present for this service. Services are to be
				congruent with the age, strengths, needed accommodations for disability, and
				cultural framework of the beneficiary and his/her family. These services are to
				be utilized to identify and address marital/family dynamics and
				improve/strengthen marital/family interactions and functioning in relationship
				to the beneficiary, the beneficiary's condition and the condition's impact on
				the marital/family relationship.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* Individual Outpatient - Speech Therapy, Speech Language
				Pathologist Scheduled individual outpatient care provided by a licensed speech
				pathologist supervised by a physician to a Medicaid-eligible beneficiary for
				the purpose of treatment and remediation of a communicative disorder deemed
				medically necessary. See the Occupational, Physical and Speech Therapy Program
				Provider Manual for specifics of the speech therapy services.
This service must be performed by licensed speech
				language pathologist and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* Individual Outpatient - Speech Therapy, Speech Language
				Pathologist Assistant
Scheduled individual outpatient care provided by a licensed
				speech pathologist assistant supervised by a qualified speech language
				pathologist to a Medicaid-eligible beneficiary for the purpose of treatment and
				remediation of a communicative disorder deemed medically necessary. See the
				Occupational, Physical and Speech Therapy Program Provider Manual for specifics
				of the speech therapy services.
This service must be performed by licensed speech
				language pathologist assistant and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
* Group Outpatient - Speech Therapy, Speech Language
				Pathologist Contact between a group of Medicaid-eligible beneficiaries and a
				speech pathologist for the purpose of speech therapy and remediation. See the
				Occupational, Physical and Speech Therapy Provider Manual for specifics of the
				speech therapy services.
Group Outpatient - Speech Therapy, Speech Language Pathologist
				Assistant
Contact between a group of Medicaid-eligible beneficiaries and
				a speech pathologist assistant for the purpose of speech therapy and
				remediation. See the Occupational, Physical and Speech Therapy Provider Manual
				for specifics of the speech therapy services.
This service must be performed by licensed speech
				language pathologist and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
*
SERVICE: Group Outpatient - Group
				Psychotherapy DEFINITION: Face-to-face interventions provided to a group of
				beneficiaries on a regularly scheduled basis to improve behavioral or cognitive
				problems which either cause or exacerbate mental illness.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
The professional uses the emotional interactions of the group's
				members to assist them in implementing each beneficiary's master treatment
				plan. Services are to be congruent with the age, strengths, needed
				accommodation for any disability, and cultural framework of the beneficiary and
				his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Therapeutic Day/Acute Day Treatment
DEFINITION: This service includes the administration of
				individual, family/marital and group therapies, face to face interventions and
				supportive services and is designed to be more intensive in nature than
				rehabilitative day services.
The providers are a combination of licensed professionals
				(psychologist, LCSW, LPC, LPE, RN, and paraprofessionals. Licensed
				professionals must supervise the milieu and a physician must provide oversight.
				Paraprofessionals must be supervised by a licensed professional.
Short-term daily array of continuous, highly structured,
				intensive outpatient services provided by a mental health professional. These
				services are for beneficiaries experiencing acute psychiatric symptoms that may
				result in the beneficiary being in imminent danger of psychiatric
				hospitalization and are designed to stabilize the acute symptoms. These direct
				therapy and medical services are intended to be an alternative to inpatient
				psychiatric care and are expected to reasonably improve or maintain the
				beneficiary's condition and functional level to prevent hospitalization and
				assist with assimilation to his/her community after an inpatient psychiatric
				stay of any length. These services are to be provided by a team consisting of
				mental health clinicians, paraprofessionals and nurses, with physician
				oversight and availability. The team composition may vary depending on clinical
				and programmatic needs but must at a minimum include a licensed mental health
				clinician and physician who provide services and oversight. Services are to be
				congruent with the age,
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
strengths, needed accommodation for any disability, and
				cultural framework of the beneficiary and his/her family.
These services must include constant staff supervision of
				beneficiaries and physician oversight.
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Crisis Intervention
DEFINITION: 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.)
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
*
SERVICE: Physical Examination - Psychiatrist
				or Physician Physical Examination - Psychiatric Mental Health Clinical Nurse
				Specialist or Psychiatric Mental Health Advanced Nurse Practitioner
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
DEFINITION: A general multisystem examination based on age and
				risk factors to determine the state of health of an enrolled RSPMI
				beneficiary.
This service must be performed by a psychiatrist,
				physician, psychiatric mental health clinical nurse specialist or psychiatric
				mental health advanced nurse practitioner and is necessary as part of an array
				of other rehabilitative treatment services used together when clinically
				indicated according to a master treatment plan for maximum reduction of a
				mental disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Pharmacologic Management by Physician (formerly
				Medication Maintenance by a physician)
Pharmacologic Management by Mental Health Clinical Nurse
				Specialist or Psychiatric Mental Health Advanced Nurse Practitioner DEFINITION:
				Provision of service tailored to reduce, stabilize or eliminate psychiatric
				symptoms by addressing individual goals in the master treatment plan. 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, necessary accommodations for any disability, and cultural framework
				of the beneficiary and his/her family.
This service must be performed by a psychiatrist,
				physician, psychiatric mental health clinical nurse specialist or psychiatric
				mental health advanced nurse practitioner and is necessary as part of an array
				of other rehabilitative treatment services used together when clinically
				indicated according to a master treatment plan for maximum reduction of a
				mental disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* SERVICE: Medication Administration by a Licensed Nurse
				DEFINITION: Administration of a physician-prescribed medication to a
				beneficiary. This includes preparing the beneficiary and medication; actual
				administration of oral, intramuscular and/or subcutaneous medication;
				observation of the beneficiary after administration and any possible adverse
				reactions; and returning the medication to its previous storage.
This service must be performed by a qualified, licensed
				health care professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Group Outpatient - Pharmacologic Management by a
				Physician
DEFINITION: Therapeutic intervention provided to a group of
				beneficiaries by a licensed physician involving evaluation and maintenance of
				the Medicaid-eligible beneficiary on a medication regimen with simultaneous
				supportive psychotherapy in a group setting. This includes evaluating
				medication prescription, administration, monitoring, and supervision; and
				informing beneficiaries regarding medication(s) and its potential effects and
				side effects. Services are to be congruent with the age, strengths, necessary
				accommodations for any disability, and cultural framework of the beneficiary
				and his/her family.
This service must be performed by a physician and is
				necessary as part of an array of other rehabilitative treatment services used
				together when clinically indicated according to a master treatment plan for
				maximum reduction of a mental disability and to restore the beneficiary to his
				or her best possible functional level
Please refer to Provider Qualifications on page
				5dl8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
* SERVICE: Routine Venipuncture for Collection of Specimen
				DEFINITION: The process of drawing a blood sample through venipuncture (i.e.,
				inserting a needle into a vein to draw the specimen with a syringe or
				vacutainer) or collecting a urine sample by catheterization as ordered by a
				physician or psychiatrist.
This service must be performed by a qualified, licensed
				health care professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Collateral Intervention, Mental Health Professional
				DEFINITION: A face-to-face contact by a mental health professional with
				caregivers, family members, other community-based service providers or other
				Participants on behalf of and with the expressed written consent of an
				identified beneficiary in order to obtain or share relevant information
				necessary to the enrolled beneficiary's assessment, master treatment plan ,
				and/or rehabilitation. The identified beneficiary does not have to be present
				for this service. Services are to be congruent with the age, strengths, needed
				accommodations for any disability, and cultural framework of the beneficiary
				and his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
*
SERVICE: Collateral Intervention, Mental
				Health Paraprofessional DEFINITION: A face-to-face contact by a mental health
				paraprofessional with caregivers, family members, other community-based service
				providers or other Participants on behalf of and with the expressed written
				consent of an identified beneficiary in order to obtain or share relevant
				information
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
necessary to the enrolled beneficiary's assessment, master
				treatment plan, and/or rehabilitation. Services are to be congruent with the
				age, strengths, needed accommodation for any disability, and cultural framework
				of the beneficiary and his/her family. The identified beneficiary does not have
				to be present for this service.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Crisis Stabilization Intervention, Mental Health
				Professional
DEFINITION: Scheduled face-to-face treatment activities
				provided to a beneficiary who has recently experienced a psychiatric or
				behavioral crisis that are expected to further stabilize, prevent
				deterioration, and serve as an alternative to 24-hour inpatient care. Services
				are to be congruent with the age, strengths, needed accommodation for any
				disability, and cultural framework of the beneficiary and his/her family.
This service must be performed by a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level.
Please refer to Provider Qualifications on page
				5dl8.
*
SERVICE: Crisis Stabilization Intervention,
				Mental Health Paraprofessional
DEFINITION: Scheduled face-to-face treatment activities
				provided to a beneficiary who has recently experienced a psychiatric or
				behavioral crisis that are expected to further stabilize, prevent
				deterioration, and serve as an alternative to 24-hour inpatient care. Services
				are to be
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
congruent with the age, strengths, needed accommodation for any
				disability, and cultural framework of the beneficiary and his/her
				family.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Intervention, Mental Health Professional (formerly
				On-Site and Off-Site Interventions, MHP)
DEFINITION: Face-to-face medically necessary treatment
				activities provided to a beneficiary consisting of specific therapeutic
				interventions as prescribed on the master treatment plan to re-direct a
				beneficiary from a psychiatric or behavioral regression or to improve the
				beneficiary's progress toward specific goal(s) and outcomes. These activities
				may be either scheduled or unscheduled as the goal warrants. Services are to be
				congruent with the age, strengths, necessary accommodations for any disability,
				and cultural framework of the beneficiary and his/her family.
This service must be performed by a licensed mental
				health professional and is necessary as part of an array of other
				rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Intervention, Mental Health Paraprofessional
				(formerly On-Site and Off-Site Intervention, Mental Health Paraprofessional)
				DEFINITION: Face-to-face, medically necessary treatment activities provided to
				a beneficiary consisting of specific therapeutic interventions prescribed on
				the master treatment plan, which are expected to accomplish a specific goal or
				objective listed on the master
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
treatment plan. These activities may be either scheduled
				or unscheduled as the goal or objective warrants. Services are to be congruent
				with the age, strengths, necessary accommodations for any disability, and
				cultural framework of the beneficiary and his/her family.
This service must be performed by a mental health
				paraprofessional under the supervision of a licensed mental health professional
				and is necessary as part of an array of other rehabilitative treatment services
				used together when clinically indicated according to a master treatment plan
				for maximum reduction of a mental disability and to restore the beneficiary to
				his or her best possible functional level
Please refer to Provider Qualifications on page
				5dl8.
* SERVICE: Rehabilitative Day Service for Persons under
				Age 18 DEFINITION: An array of face-to-face interventions providing a
				preplanned and structured group program for identified beneficiaries that
				improve emotional and behavioral symptoms of youth diagnosed with childhood
				disorders, as distinguished from the symptom stabilization function of acute
				day treatment. These interventions are person- and family-centered,
				age-appropriate, recovery based, culturally competent, must reasonably
				accommodate disability, and must have measurable outcomes. These activities are
				designed to assist the beneficiary with compensating for or eliminating
				functional deficits and interpersonal and/or environmental barriers associated
				with their mental illness. The intent of these services is to enhance a youth's
				functioning in the home, school, and community with the least amount of ongoing
				professional intervention. Skills addressed may include: emotional skills, such
				as coping with stress, anxiety, or anger; behavioral skills, such as positive
				peer interactions, appropriate social/family interactions, and managing overt
				expression of symptoms like impulsivity and anger; daily living and self-care
				skills, such as personal care and hygiene, and daily structure/use of time;
				cognitive skills, such as problem solving, developing a positive self-esteem,
				and reframing, money management, community integration, understanding illness,
				symptoms and the proper use of medications; and any similar skills required to
				implement a beneficiary's master treatment plan.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level
Please refer to Provider Qualifications on page
				5dl8.
* Rehabilitative Day Service for Persons Ages 18-20
Apply the above definition and requirements (except Staff to
				Client Ratios, which are outlined below).
Additional information: Use code H2017 with no modifier to
				claim for services provided to beneficiaries for ages 18-20.
* SERVICE: Adult Rehabilitative Day Service
DEFINITION: Adult Rehabilitative day services provide a
				continuing, organized program of rehabilitative, therapeutic and supportive
				health services, and supervision to individuals who are mentally ill and who,
				due to the severity of their impairment, are in need of face to face
				interventions provided in a structured group program. This service is designed
				for long-term recovery and self-sufficiency.
Adult Rehabilitative day services provide rehabilitative and
				health services directed toward meeting the health restoration and maintenance
				needs of the beneficiary in a facility-based program providing specialized
				rehabilitation.
Services may include:
A. Goal compliance,
B. Problem solving,
C. Patient Safety
D. Task completion
E. Pharmaceutical supervision and/or G.
			 Health monitoring.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
An array of face-to-face interventions providing a
				preplanned and structured group program for identified beneficiaries that aimed
				at long-term recovery and maximization of self-sufficiency, as distinguished
				from the symptom stabilization function of acute day treatment. These
				interventions are person- and family-centered, recovery based, culturally
				competent, provide needed accommodation for any disability and must have
				measurable outcomes. These activities assist the beneficiary with compensating
				for or eliminating functional deficits and interpersonal and/or environmental
				barriers associated with their chronic mental illness. The intent of these
				services is to restore the fullest possible integration of the beneficiary as
				an active and productive member of his/her family, social and work community
				and/or culture with the least amount of ongoing professional intervention.
				Skills addressed may include: emotional skills, such as coping with stress,
				anxiety, or anger; behavioral skills, such as proper use of medications,
				appropriate social interactions, and managing overt expression of symptoms like
				delusions or hallucinations; daily living and self-care skills, such as
				personal care and hygiene, money management, and daily structure/use of time;
				cognitive skills, such as problem solving, understanding illness and symptoms,
				and refraining; community integration skills and any similar skills required to
				implement a beneficiary's master treatment plan.
This service also includes the administration of
				individual intervention services, individual therapy, group therapy and
				supportive services, but are designed to assist with beneficiary functioning on
				a day to day basis within the community.
The providers are licensed mental health professionals
				and paraprofessionals under their supervision.
This service must be performed and overseen by a
				multidisciplinary team of physician, licensed mental health professional and
				mental health paraprofessional staff and is necessary as part of an array of
				other rehabilitative treatment services used together when clinically indicated
				according to a master treatment plan for maximum reduction of a mental
				disability and to restore the beneficiary to his or her best possible
				functional level.
Please refer to Provider Qualifications on page
				5dl8.
Coverage authority for these mental health rehabilitative
				services expires on September 1,2010.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
d. Rehabilitative Services
B.
Provider Qualifications
Rehabilitative Services for Persons with Mental Illness (RSPMI)
				are limited to certified providers who offer core mental health services for
				the treatment and prevention of mental disorders.
The provider must be
				certified as an RSPMI provider by the Division of Behavioral Health Services.
				Providers not certified by the Division of Behavioral Health Services may not
				provide these services.
Providers for each specific RSPMI service are licensed by
				the State and must practice within the scope of Arkansas licensure. Individuals
				providing RSPMI services must be:
1.
Licensed in the State of Arkansas as
			 a mental health professional.;
2.
Medical records
			 librarian;
3.
Licensed
			 in the State of Arkansas as a Psychiatrist - The psychiatrist may provide
			 oversight, medical care, or both. If the psychiatrist does not provide all
			 medically necessary RSPMI medical care, then a medical doctor may provide
			 medical care in addition to a psychiatrist;
4.
Licensed Psychologist or Licensed
			 Psychological Examiner
5.
Licensed Physician or
6.
Certified Mental Health
			 Paraprofessional, under the direct supervision of a Licensed Mental Health
			 Professional Qualified professionals must be present to furnish all medically
			 necessary RSPMI services, including all services in each patient's care plan
			 Coverage authority for these mental health rehabilitative services expires on
			 September 1,2010.
12. Prescribed drugs, dentures, and
			 prosthetic devices; and eyeglasses prescribed by a physician skilled in
			 diseases of the eye or by an optometrist
d.
			 Eyeglasses Negotiated statewide contract bid.
13. Other diagnostic, screening, preventive
			 and rehabilitative services, i.e., other than those provided elsewhere in this
			 plan.
a. Diagnostic Services - Not
			 provided.
b. Screening Services -
			 Not provided.
c. Preventive
			 Services - Not provided.
e.
			 Rehabilitative Services
1. Rehabilitative
			 Services for Persons with Mental Illness
(RSPMI)
Reimbursement is based on the lower of the amount billed or the
				Title XIX (Medicaid) maximum allowable.
Except as otherwise noted in the
				state plan, state developed fee schedule rates are the same for both
				governmental and private providers of RSPMI services. The agency's fee schedule
				rates were set as of April 1,1988 and are effective for services provided on or
				after that date. All rates are published on the agency's website at
www.medicaid.state.ar.us
.
Effective for dates of service on or after April 1, 2004,
				reimbursement rates (payments) for inpatient visits in acute care hospitals by
				board certified psychiatrists shall be as ordered by the United States District
				Court for the Eastern District of Arkansas in the case of Arkansas Medical
				Society v. Reynolds. Refer to Attachment 4.19-B, Item 5, for physician
				reimbursement.
For RSPMI services provided in clinics operated by State
				operated teaching hospitals.
Effective for claims with dates of service on or after March 1,
				2002, Arkansas State Operated Teaching Hospital psychiatric clinics that are
				not part of a hospital outpatient department shall be reimbursed based on
				reasonable costs with interim payments
at the RSPMI fee schedule
				rates
and a year-end cost settlement.
The provider will be paid
				the
lesser of
actual
costs
identified using a CMS
				approved cost report
or customary charges.
Each Arkansas State
				Operated Teaching Hospital with qualifying psychiatric clinics shall submit an
				annual cost report. Said cost report shall be submitted within five (5) months
				after the close of the hospital's fiscal year. Failure to file the cost report
				within the prescribed period, except as expressly extended by the State
				Medicaid Agency, may result in suspension of reimbursement until the cost
				report is filed. The State Medicaid Agency will review the submitted cost
				report and make a tentative settlement within 60 days of the receipt of the
				cost report and will make final settlement in the following year after all
				Medicaid charges and payments have been processed. The final settlement will be
				calculated and made at the same time as the next year's tentative settlement is
				calculated and made.
Medical professionals affiliated with
Arkansas State
				Operated Teaching Hospitals
are not eligible for additional
				reimbursement for services provided in these clinics.
Reimbursement authority for these mental health services
				expires on September 1, 2010.