Medicaid Mental Health Rehabilitation Program Enhancements Overview
Medicaid's Mental Health Rehabilitation (MHR) program underwent significant enhancements, spearheaded by a collaborative effort involving MHR providers, Managed Care Organizations (MCOs), and legislative bodies in Louisiana. The reforms aimed to refine services like Community Psychiatric Supportive Treatment (CPST) and Psychosocial Rehabilitation (PSR), ensuring distinctiveness and sustainability within the Medicaid system. Key elements included improved service definitions, diversified provider types, and an emphasis on evidence-based practices, all under pending CMS approval for implementation in 2023.
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MHR Redesign NOVEMBER 2022 ALL PROVIDER CALL
Meet Your Team DR. JAMIE HANNA, MEDICAL DIRECTOR WENDY BOWLIN, QUALITY DIRECTOR JAY GANESAN, NETWORK MANAGEMENT SPECIALIST, ROSTER STAFF SUPPORT GAIL FOWLER, NETWORK DIRECTOR BRANDI JOHNSTON, CLINICAL DIRECTOR SHARONDA GRAY NETWORK MANAGEMENT SPECIALIST, CONTRACTING, RATES SUPPORT LINDA REDDIX NETWORK MANAGEMENT SPECIALIST, PROVIDER COMMUNICATIONS SUPPORT 2
Agenda Mental Health Rehabilitation New Service Definitions New Provider Types and Rates
Mental Health Rehabilitation Mental Health Rehabilitation, or MHR, is one behavioral health provider type within the Medicaid system. Two of the services of focus include Community Psychiatric Supportive Treatment (CPST) and Psychosocial Rehabilitation (PSR) which are home and community-based services. In 2019 and 2020 for approximately 18 months, the Office of Behavioral Health (OBH) collaborated with MHR providers and the five Managed Care Organizations (MCOs) to develop and implement reforms to the MHR program. To facilitate conversations around these changes, the Office of Behavioral Health (OBH) hosted monthly MHR Stakeholder Group meetings, including breakout sessions for focused discussions. One of the recommendations that came from the workgroup was a complete overhaul of the CPST and PSR services definitions. The Louisiana Legislature passed Senate Bill 213, and Governor John Bel Edwards signed it as Act 503. The legislation renews the integrity and sustainability of the Medicaid Mental Health Rehabilitation (MHR) program by increasing distinction between Community Psychiatric Support and Treatment (CPST) and Psychosocial Rehabilitation (PSR) services and by expanding utilized provider types for CPST services. Pending CMS approval, the anticipated effective date will be January 1, 2023. 4
Workgroup, Considerations and Recommendations Workgroup Began March 2019 Comprised of any interested MHR providers, MCO representatives, and LDH representatives Grew from 20 participants to 54 participants Met monthly or more frequently as needed Drafted definitions presented December 2019 Considerations Difficulty in distinguishing differences in CPST and PSR What is and isn t CPST and what is or isn t PSR Avoid duplication of services Bring back counseling component of CPST Increase opportunities for delivery of evidence-based practices 5
Workgroup, Considerations and Recommendations continued Other Considerations Improve quality of service Increase opportunities for quality outcomes Increase potential provider agency marketability Improve integrity of the program Improve workforce development Recommendations PSR The PSR definition is amended to focus exclusively on skills-building components as supportive interventions to promote independent functioning and to remove psycho-education components. PSR manualized or delivered in accordance with a nationally accepted protocol. Directed toward a particular symptom and works on increasing or reducing a particular behavior. CPST The CPST definition includes a focus on clinically-oriented components, including assessment, treatment planning, and counseling and clinical psycho-education. All skills-building components are moved to the PSR definition. 6
Psychosocial Rehabilitation Psychosocial rehabilitation (PSR) services are designed to assist the individual with compensating for or eliminating functional deficits and interpersonal and/or environmental barriers associated with their mental illness. Activities included must be intended to achieve the identified goals or objectives as set forth in the individual s individualized treatment plan. The intent of PSR is to restore the fullest possible integration of the individual as an active and productive member of his or her family, community and/or culture with the least amount of ongoing professional intervention. PSR is a face-to-face intervention with the individual present. Services may be provided individually or in a group setting. Most contacts occur in community locations where the person lives, works, attends school and/or socializes. 8
Psychosocial Rehabilitation - continued Components Skills building includes the practice and reinforcement of independent living skills, use of community resources and daily self-care routines. The primary focus is to increase the basic skills that promote independent functioning so the member can remain in a natural community location and achieve developmentally appropriate functioning, and assisting the member with effectively responding to or avoiding identified precursors or triggers that result in functional impairment. Supporting the restoration and rehabilitation of social and interpersonal skills to increase community tenure, enhance personal relationships, establish support networks, increase community awareness, develop coping strategies and effective functioning in the individual s social environment, including home, work and school; and Supporting the restoration and rehabilitation of daily living skills to improve self-management of the negative effects of psychiatric or emotional symptoms that interfere with a person s daily living. Supporting the individual with development and implementation of daily living skills and daily routines necessary to remain in home, school, work and community. 9
Community Psychiatric Support and Treatment CPST is designed to reduce disability from mental illness, restore functional skills of daily living, build natural supports and achieve identified person-centered goals or objectives through counseling, clinical psycho-education, and ongoing monitoring needs as set forth in an individualized treatment plan. 10
CPST Components Performed by an LMHP Initial and annual assessment, including the LOCUS/CALOCUS. Development of a treatment plan in collaboration with the member and family if applicable (or other collateral contacts) on the specific strengths and needs, resources, natural supports, and individual goals and objectives for the member. The overarching focus is to utilize the personal strengths, resources, and natural supports to reduce functional deficits associated with their mental illness and increase restoration of independent functioning. The treatment plan must include developing a crisis management plan. Components Performed by an LMHP or other qualified professional as defined in staff qualifications Ongoing monitoring of needs including triggering an update of the treatment plan by the LMHP if needs change significantly. Counseling, including mental health interventions that address symptoms, behaviors, thought processes, that assist the member in eliminating barriers to treatment and identifying triggers. Counseling includes assisting the member with effectively responding to or avoiding identified precursors or triggers that would impact the member s ability to remain in a natural community location. The use of evidenced based practices/strategies is encouraged. Clinical psycho-education includes using therapeutic interventions to provide information and support to better understand and cope with the illness. The illness is the object of treatment, not the family. The goal is for therapist, members, and families to work together to support recovery, including assisting the individual and family members, or other collaterals, with identifying a potential psychiatric or personal crisis. 11
CPST Provider Qualifications and Rates By redesigning the CPST service to offer counseling, the list of clinical practitioners that can deliver CPST will expand to the following: Licensed Mental Health Professionals (LMHP) Provisionally Licensed Professional Counselor (PLPC) Provisionally Licensed Marriage and Family Therapist (PLMFT) Licensed Master Social Worker (LMSW) Certified Social Worker (CSW) Psychology intern from an American Psychological Association approved internship program. SPECIALIZED BEHAVIORAL HEALTH SERVICES - RATES EFFECTIVE JANUARY 1, 2023* Universal Rate Code Description Modifier Unit HEALTH BEHAVIOR ASSESSMENT, OR REASSESSMENT - CPST (COMMUNITY) 96156 TG, U8 Visit $163.26 HEALTH BEHAVIOR ASSESSMENT, OR REASSESSMENT - CPST (OFFICE) $128.58 96156 TG Visit Services provided by a non-LMHP must be provided under regularly scheduled supervision in accordance with requirements established by the practitioner s professional licensing board and in accordance with the agency s accrediting body. SPECIALIZED BEHAVIORAL HEALTH SERVICES - RATES EFFECTIVE JANUARY 1, 2023* Universal Rate Code Description Modifier Unit Currently, to be eligible for Medicaid reimbursement for assessment and counseling services in Louisiana, the provider must be a fully licensed mental health professional (LMHP) able to practice independently. COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT - INDIVIDUAL OFFICE H0036 15 min $21.43 COMMUNITY PSYCHIATRIC SUPPORTIVE TREATMENT - INDIVIDUAL COMMUNITY H0036 U8 15 min $27.21 13
PSR Provider Qualifications and Rates Any individual rendering PSR services for a licensed and accredited provider agency shall hold a minimum of one of the following: A bachelor s degree from an accredited university or college in the field of counseling, social work, psychology, sociology, rehabilitation services, special education, early childhood education, secondary education, family and consumer sciences, criminal justice, or human growth and development; or A bachelor s degree from an accredited university or college with a minor in counseling, social work, sociology, or psychology; or A high school diploma or equivalency and have been continuously employed by a licensed and accredited agency providing PSR services since prior to January 1, 2019. A maximum of 50% of the individual and group supervision may be telephonic or via a secure Health Insurance Portability and Accountability Act (HIPAA) compliant online synchronous videoconferencing platform. Texts and/or emails cannot be used as a form of supervision to satisfy this requirement. SPECIALIZED BEHAVIORAL HEALTH SERVICES - RATES EFFECTIVE JANUARY 1, 2023* Master's Bachelor's Level Level Universal Rate Grandfathered HS Diploma (HM) Code Description Modifier Unit (HO) (HN) 15 min H2017 PSYCHOSOCIAL REHABILITATION - OFFICE 14.87 12.01 10.99 PSYCHOSOCIAL REHABILITATION - INDIVIDUAL COMMUNITY 15 min H2017 U8 $20.28 $14.14 $12.67 PSYCHOSOCIAL REHABILITATION - GROUP OFFICE 15 min H2017 HQ $2.40 PSYCHOSOCIAL REHABILITATION - GROUP COMMUNITY 15 min Effective January 1, 2022 PSR providers must be 21 years old. H2017 HQ, U8 $2.76 14
CPST OBH engaged in several conversations with the Louisiana State Board of Licensed Professional Counselors and the Louisiana State Board of Social Work Examiners. Both boards have agreed to e-blast their licensees about the MHR Redesign and potential job opportunities with MHR agencies in the state. They recognize that the redesign offers new opportunities for certified and provisionally licensed clinicians to utilize their clinical practice skills in the Medicaid space, where it s not been approved before. The Louisiana State Board of Professional Counselors will post job announcements to their website. MHR agencies are encouraged to make that request directly to the Board. 16
CPST - continued Certified Social Worker (CSW) Master s degree from accredited graduate school (this is what you get when you first graduate from a master s program after submitting proof of graduation/transcripts to LASWB, (Louisiana State Board of Social Work Examiners), Licensed Masters Level Social Worker (LMSW) Master s degree from accredited graduate school and passing the Master s ASWB exam o Individual can practice clinical work only under the supervision of a LCSW. o Typically, an individual will stay an LMSW for about 2-3 years while working towards LCSW. o If an individual does not pass LCSW exam and/or does not accrue their supervision hours, they can remain a LMSW indefinitely. To be a Provisional Licensed Marriage and Family Therapist (PLMFT) o COAMFTE (Commission on Accreditation for Marriage and Family Therapy Education) approved graduate degree program or 60-hour degree in marriage and family therapy/counseling or a related clinical mental health field from a regionally accredited educational institution o Document a minimum of 3000 hours of post-masters supervised experience in marriage and family therapy under the clinical supervision of a Board -Approved Supervisor including a minimum of 2000 direct client contact hours, minimum of 1000 direct client contact hours, and a minimum of 200 face-to-face supervision hours. Post master s supervision experience should occur over a period no less than two years and not more than 6 years from the original date such supervision was approved. PLPC - The requirements for professional counselors in Louisiana often include a graduate degree and testing requirements. The Louisiana State Board of Licensed Professional Counselors issues licenses for mental health counselors in Louisiana. You must have a 60-credit graduate degree in mental health counseling or a related field from an accredited school. o To begin the licensure process, you must register as a provisional licensed professional counselor (PLPC) o Once you have received your PLPC license, you must earn at least 3,000 hours of supervised clinical work experience supervised by an approved professional. This should include at least 1,900 hours of direct client contact, 1,000 hours of indirect client contact, and 100 face-to-face supervision hours. This experience should be accrued in no less than two years, but not more than six years. Psychology intern from an American Psychological Association approved internship program. o In Louisiana, you must earn your doctoral degree from a program that meets certain educational requirements set forth by the Louisiana State Board of Examiners of Psychologists o If your doctoral degree is in an area of psychology that involves working directly with patients, your training must also include at least 300 hours of supervised practicum experience and 1,500 supervised internship hours in a healthcare setting. Licensed Clinical Social Worker (LCSW) Master s degree from accredited graduate school, 3,000 hours of post graduate social work experience under the supervision of a board approved clinical supervisor, 96 face-to-face supervision hours, passing of the ASWB clinical exam o Fully independent license type. o Each level of license type requires documentation to be submitted to the Louisiana State Board of Social Work Examiners for approval. 17
Next Steps Agency To Do List Magellan s To Do List Question and Answers
Agency To Do List Provider agencies to submit rosters and copies of license/certifications/documentation for these provider types: Provisionally Licensed Professional Counselor (PLPC) Provisionally Licensed Marriage and Family Therapist (PLMFT) Licensed Master Social Worker (LMSW) Certified Social Worker (CSW) Psychology intern from an American Psychological Association approved internship program Provider agencies must also submit updated roster for PSR staff We must receive your completed rosters no later than December 7, 2022. Please submit only your provisionally/certified roster staff using the Organizational Behavioral Health Roster Staff form to SJGanesan@magellanhealth.com. CPST services will no longer require a degree modifier EHR systems will need to be updated Staff trained Assessments for CPST will require a TG modifier EHR systems will need to be updated to include TG modifier Claims should be submitted for 1 unit Staff trained All Other Assessments will require a degree modifier EHR systems will need to be updated to include degree/license type modifier Claims should be submitted with number of units Staff trained Authorizations If additional units are needed, follow the Child and Family Team process of submitting a plan of care with strategies supporting the services 19
Magellan To Do List Load provisionally/certified/documented staff into provider database Update staff rate tables for PSR staff based on updated rosters received from agencies Update CPST licensed staff to exclude degree modifier Add rates for CPST, without degree modifier for provisionally/certified staff Add rates for licensed staff for CPST assessment to include TG modifier Update agency provider fee schedules Send amended and mail provider contracts to include new fee schedules Configure Magellan systems for claims payment Continue providing updates as applicable Continue to support our providers throughout the changes Authorizations There will be no major changes to authorizations for youth enrolled in CSoC Authorizations for CSoC youth will continue to be provided based on the member s plan of care 20
Confidentiality statement By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc. The information contained in this presentation is intended for educational purposes only and is not intended to define a standard of care or exclusive course of treatment, nor be a substitute for treatment. *If the presentation includes legal information (e.g., an explanation of parity or HIPAA), add this: The information contained in this presentation is intended for educational purposes only and should not be considered legal advice. Recipients are encouraged to obtain legal guidance from their own legal advisors. 23
