Covered services of the PNMI Per-Diem rate (the fee paid, per recipient day, to a PNMI Provider) includes a spectrum of mental health care services. Designated Agencies/Specialized Services Agencies may deliver Service Planning and Coordination or Community Supports for discharge planning/transition/aftercare coordination (see sections 3.6 & 3.7 for requirements). 1.6 Provider Eligibility Provider numbers are issued for the provision of specific types of services such as mental health services, developmental services, services in a detoxification facility, neurological services or general medical services. Only services specifically allowed under a given provider number will be reimbursed. In cases where multiple provider numbers are issued to a DA, DMH staff will have access to settlement sheets documenting payments under each number. Ongoing Medicaid review activities by DMH will include verification that double payments are not made under multiple provider numbers for the same service. 1.6.1 Staff Qualifications Specific staff requirements for services will be included in the appropriate section. Staff qualifications also apply to contracted employees, interns, and sub-contracted entities. 1.7 Documentation Standards Documentation of services provided must be legible, of sufficient clarity, and sufficient clinical content (minimum required content is specified for each service) to ensure eligibility for payment. Auditors must be able to read the service documentation. All clinical and support notes must include: Identification of the individual served The date the service was rendered The specific or code of the service rendered Location in which the service occurred The amount of time it took to deliver the service Reference to the treatment goal for the service Summary of the service rendered with appropriate clinical content (refer to specific service documentation requirements)
Face-to-Face Intervention guidelines: One progress note per face-to-face contact is required to document the emergency care and assessment services provided to an individual. It must include, in summary form: Identified issue or precipitant to crisis contact; Issues addressed or discussed; Collateral contact information as solicited or available; Observations made by the clinician; The clinician’s assessment of the issues/situation including mental status and lethality/risk potential; Disposition or plan resulting from the crisis intervention; Psychiatric consultation, as clinically indicated. It is acceptable to document telephone and face-to-face Emergency Care and Assessment Services in a logbook only if all documentation requirements are present. 2.10 Facility-Based Crisis Stabilization and Support Services Definition Facility-based Crisis Stabilization, Support, and Referral Services are focused and ongoing support services provided to individuals, their families, or their immediate support system that may be time-limited, but necessary to maintain stability or avert destabilization of an expected psychological, behavioral, or emotional crisis. Services are provided to persons experiencing mental health crisis as evidenced by: (1) a progressing change in behavior with negative consequences for well-being; (2) declining or loss of usual coping mechanisms; or, (3) increasing risk of danger to self or others. Crisis stabilization services are face-to-face services in an environment other than a person’s home. Support and referral includes triaging aftercare needs, supportive counseling, skills training, symptom management, medication monitoring, crisis planning, and assistance with referrals from crisis stabilization in a person’s home or by phone. These services are available 24 hours a day, 7 days a week. Attributes Mental health services cannot be billed during the time period billed to crisis stabilization services.
The SFI designation is to be used to define services for individuals who have approved budgets associated with care. It is reimbursed as a bundled rate that is negotiated with the DA/SSA for each specific individual. The SFI modifier must be used. Staff Qualifications SFI Programming must be authorized in the consumer’s Individualized Plan of Care. For specifics please see Plan Necessity of Section 2.1 Individual Plan of Care (IPC) of this document. The service must be provided by staff of the Designated Agency/Specialized Services Agency or a qualified provider subcontracted by the Designated Agency/Specialized Services Agency who, based on his/her education, training, or experience, is authorized by the Designated Agency’s/Specialized Services Agency’s Medical Director as competent to provide the service. Section 3 – Child Medicaid Fee-For-Service Traditional Medicaid Recipients Clinical & Support Services For Designated Agencies participating in Integrating Family Services (IFS), please refer to the IFS Manual (). 3.1 Individual Plan of Care (IPC) Medicaid eligible individual must have an authorized Individual Plan of Care (IPC) in their chart within 30 days of intake for services. The IPC is directly related to assessments and must encompass, at a minimum, the services identified in the plan and provided by the designated agency to the individual. It must contain the following components: A statement of the mutually desired overall, long range results of interventions expressed in the individual’s words as much as possible. These are often stated in the client’s words and tend to be long-term focused. Objectives: A statement of the specific individual skills and/or community resources that need to be changed or modified to achieve each goal. Objectives are to be stated in observable and measurable terms that are easily understood by the client/family. Interventions: A description of the interventions to be used to achieve each objective including: The staff position or service component responsible; The intervention activity (service provided); The frequency of the activity (measurable). PRN or “as needed” frequency is reserved for emergent or episodic service delivery. It is acceptable to identify a range of treatment frequency for planned services or interventions. Such