Updates to Community Mental Health Rehabilitative Services (CMHRS) Developmental Disabilities and Behavioral Health Unit Virginia Department of Medical Assistance Services

 
UPDATES TO COMMUNITY MENTAL HEALTH
REHABILITATIVE SERVICES (CMHRS)
 
Developmental Disabilities and
Behavioral Health Unit
Virginia Department of Medical
Assistance Services
 
 
Agenda
 
2
 
Reviewing the most recent CMHRS Medicaid Memo
that reflects changes to the CMHRS Provider Manual
to include the following:
Implementing the Comprehensive Needs Assessment
(effective January 1, 2019);
Clarifying the recommendation for a psychiatric
evaluation in Crisis Stabilization services; and
Removing the At Risk of Physical Injury form (P502)
requirement in Therapeutic Day Treatment (TDT) and
Intensive In-Home (IIH) Services.
Special recognition of participants in the development
of the memo and presentation.
 
Comprehensive Needs Assessment
 
DMAS is implementing the 
Comprehensive Needs
Assessment 
in CMHRS to allow for a single
assessment to be used when recommending one or
more CMHRS services provided by the same
Department of Behavioral Health and
Developmental Services (DBHDS) licensed agency.
Allowing one Comprehensive Needs Assessment in
place of multiple Service-Specific Provider Intakes
(SSPIs) is intended to 
support efficiency and access
to care
 by reducing the time and administrative
burden on providers and members they serve.
 
3
 
Effective January 1, 2019
 
Comprehensive Needs Assessment
 
A Comprehensive Needs Assessment that follows
the guidelines in the 
CMHRS Medicaid Memo dated
November 20, 2018
, is required for new requests for
CMHRS services and for CMHRS services previously
recommended by a SSPI that is outdated (greater
than 12 months old).
SSPIs and Psychiatric Diagnostic Interviews
completed prior to January 1, 2019 will 
not
 apply to
the Comprehensive Needs Assessment criteria.
 
4
 
Effective January 1, 2019
 
Comprehensive Needs Assessment
 
Provider Black Panther performs an
Intensive In-home (IIH) SSPI for Tim, a 13
year old, on 12/7/18.  However Provider
Black Panther does not initiate services
until 1/4/2019. The SSPI would be valid for
IIH through 12/6/19.
 
5
 
Example #1
 
Provider Black Panther would not have to update the
assessment as part of a Comprehensive Needs
Assessment until 12/7/19 unless services lapse for more
than 31 days or Tim’s needs change.
 
Comprehensive Needs Assessment
 
In April 2019, Tim’s needs change and he requires
school based TDT in addition to IIH.  Provider Black
Panther is also licensed for TDT.
 
Since the assessment used for Tim’s IIH is a SSPI, it can
not be used as a Comprehensive Needs Assessment.
 
Provider Black Panther will have to conduct a new
Comprehensive Needs Assessment for TDT.
 
6
 
Example #2
 
Comprehensive Needs Assessment
 
Licensed agencies include providers with a specific DBHDS
license to provide one or more of the following services:
Intensive In-Home Services (IIH)
Psychosocial Rehabilitation (PSR)
Therapeutic Day Treatment (TDT)
Day Treatment/Partial Hospitalization
Mental Health Skill-Building (MHSS)
Intensive Community Treatment (ICT)
Crisis Stabilization
Crisis Intervention
Mental Health Case Management
 
7
 
Agency Definition
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessment, including all
addendums, shall be conducted and documented by a:
Licensed Mental Health Professional (LMHP);
LMHP-Resident (LMHP-R);
LMHP-Supervisee (LMHP-S); or
LMHP Resident in Psychology (LMHP-RP).
 
8
 
Professionals Conducting the Assessment
 
Comprehensive Needs Assessment
 
Means the 
face-to-face interaction 
in which the
provider obtains information from the individual,
and parent, guardian, or other family member or
members, as appropriate, about the individual’s
mental health status. It includes 
documented
history of the severity, intensity, and duration of
mental health problems and behavioral and
emotional issues.
 
9
 
Assessments and Reassessments
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessment must:
Document the medical necessity for each
recommended CMHRS service (including mental
health case management) provided by the
agency;
Be face-to-face with the member and appropriate
family members, guardians, or member
representative; and
Include all 15 elements previously required of the
SSPI.
 
10
 
Requirements
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessment is required
prior to the development of the Individual Service
Plan (ISP) for each service and is used as the basis
for the ISP for the entire duration of services.
All providers shall ensure they meet the DMAS
requirements as well as the DBHDS licensing
requirements for completion of assessments.
 
11
 
Requirements (continued)
 
DMAS Billing Requirements for the
Comprehensive Needs Assessment
(15 Elements)
vs
 DBHDS Licensing Requirements
 
#1 Presenting Issue(s)/Reason for Referral:
Chief Complaint
 
DMAS
 
Indicate duration, frequency
and severity of behavioral
health symptoms. Identify
precipitating events/stressors,
relevant history.) If a child is at
risk of an out of home
placement, state the specific
reason and what the out-of-
home placement may be.
 
DBHDS*
 
Presenting needs
including the individual's
stated needs, psychiatric
needs, support needs, and
the onset and duration of
problems;
Onset and duration of
problems
 
13
 
*
Italicized and Underlined
 = Initial Assessment Requirements
Bold
 = items DBHDS requires that are not required by DMAS, list is not inclusive of all differences.
Providers are responsible for ensuring compliance with DBHDS requirements.
 
#2 Behavioral Health
History/Hospitalizations:
 
DMAS
 
Give details of mental
health history and any
mental health related
hospitalizations and
diagnoses. List family
members and the dates and
the types of mental health
treatment that family
members either are
currently receiving or have
received in the past.
 
DBHDS
 
Previous interventions and
outcomes;
 
diagnosis
 
14
 
#3 Previous Interventions by providers and
timeframes and response to treatment:
 
DMAS
 
include the types of
interventions that have
been provided to the
individual. Include the date
of the mental health
interventions and the name
of the mental health
provider.
 
DBHDS
 
Previous interventions and
outcomes
 
15
 
#4 Medical Profile:
 
DMAS
 
Describe significant past and
present medical problems,
illnesses and injuries, known
allergies, current physical
complaints and medications.
As needed, conduct an
individualized fall risk
assessment to indicate whether
the individual has any physical
conditions or other impairments
that put her or him at risk for
falling. All children aged 10 years
or younger should be assessed
for fall risks based on age-specific
norms.
 
DBHDS
 
Current Medical problems
Current medications
As applicable, and in all residential services,
fall risk, communication methods or needs,
and mobility and adaptive equipment needs.
Health history and current medical care needs,
to include:
Allergies;
Recent physical complaints and medical
conditions;
Nutritional needs;
Chronic conditions;
Communicable diseases;
Restrictions on physical activities if any;
Restrictive protocols or special supervision
requirements;
Past serious illnesses, serious injuries, and
hospitalizations;
Serious illnesses and chronic conditions of the
individual's parents, siblings, and significant
others in the same household; and
Current and past substance use including
alcohol, prescription and nonprescription
medications, and illicit drugs
 
16
 
#5 Developmental History:
 
DMAS
 
Describe the individual as an infant
and as a toddler: individual’s typical
affect and level of irritability;
medical/physical
complications/illnesses; interest in
being held, fed, played with and
the parent’s ability to provide
these; parent’s feelings/thoughts
about individual as an infant and
toddler.
Was the individual significantly
delayed in reaching any
developmental milestones, if so,
describe.
Were there any significant
complications at birth?
 
DBHDS
 
17
 
Social, behavioral,
developmental, and family
history and supports;
 
History of abuse, neglect,
sexual, or domestic violence,
or trauma including
psychological trauma;
 
cognitive functioning
including strengths and
weaknesses
 
#6  Educational/Vocational Status:
 
DMAS
 
School, grade, special
education/IEP status,
academic performance,
behaviors,
suspensions/expulsions,
any changes in academic
functioning related to
stressors,
tardiness/attendance, and
peer relationships.
 
DBHDS
 
Financial resources and
benefits
Employment, vocational,
and educational
background
 
18
 
#7  Current Living Situation, Family History
and Relationships:
 
DMAS
 
Describe the daily routine and
structure, housing
arrangements, financial
resources and benefits.
Significant family history
including family conflicts,
relationships and interactions
affecting the individual and
family's functioning should be
listed along with a list of all
family or household members.
 
DBHDS
 
Social, behavioral,
developmental, and family
history and supports;
 
Housing arrangements;
 
19
 
#8  Legal Status: Indicate individual’s
criminal justice status:
 
DMAS
 
Pending charges, court
hearing date, probation
status, past convictions,
current probation
violations, past
incarcerations.
 
DBHDS
 
Legal status 
including
authorized representative,
commitment, and
representative payee
status;
 
Relevant criminal charges
or convictions and
probation or parole status;
 
20
 
#9  Drug and Alcohol Profile:
 
DMAS
 
Describe substance use by
the individual and/or family
members; specify the type
of substance with
frequency and duration of
usage.
Include any treatment or
other recovery related
efforts.
 
DBHDS
 
Current and past substance use
including alcohol, prescription
and nonprescription medications,
and illicit drugs
Psychiatric and substance use
issues including current mental
health or substance use needs,
presence of co-occurring disorders,
history of substance use or abuse,
and circumstances that increase
the individual's risk for mental
health or substance use issues;
 
21
 
#10  Resources and Strengths:
 
DMAS
 
Document individual’s
strengths, preferences,
extracurricular, community
and social activities, extended
family; activities that the
individual engages in or are
meaningful to the individual.
These elements are key to
developing an ISP that
supports the individual’s
recovery and resiliency efforts
and goals.
 
DBHDS
 
Daily living skill
 
Ability to access services
including transportation
needs
 
22
 
#11  Mental Status Profile:
 
DMAS
 
Include findings and  clinical
tools used.
 
DBHDS
 
At-risk behavior to self and
others.
 
23
 
#12  Diagnosis:
 
DMAS
 
The documentation of a
diagnosis must include the
DSM diagnostic code &
description as documented
by the LMHP that provided
the diagnosis.
 
DBHDS
 
Diagnosis
Cognitive functioning
including strengths and
weaknesses;
 
24
 
#13  Professional Comprehensive Needs
Assessment Summary and Clinical
Formulation:
 
DMAS
 
Includes a documentation of
medically necessary services
as defined by the service
provider which:
Identifies as much as possible,
the causes of presenting
treatment issues, and
Identifies and discusses
treatment options, outcomes,
and potential barriers to
progress, so that an individual
specific service plan can be
developed.
 
DBHDS
 
Psychiatric and substance use issues including
current mental health or substance use needs,
presence of co-occurring disorders, history of
substance use or abuse, and circumstances that
increase the individual's risk for mental health or
substance use issues
 
Onset and duration of problems
 
Presenting needs including the individual's stated
needs, psychiatric needs, support needs, and the
onset and duration of problems;
12VAC35-105-660.B : The provider shall develop an
initial person-centered ISP for the first 60 days for
mental retardation (intellectual disability) and
developmental disabilities services or for the first 30
days for mental health and substance abuse services.
This ISP shall be developed and implemented within
24 hours of admission to address immediate service,
health, and safety needs and shall continue in effect
until the ISP is developed or the individual is
discharged, whichever comes first.
 
25
 
#14  Recommended Care and Treatment
Goals
 
DMAS
 
To build the ISP
 
DBHDS
 
12VAC35-105-660.B : The provider
shall develop an initial person-
centered ISP for the first 60 days
for mental retardation (intellectual
disability) and developmental
disabilities services or for the first
30 days for mental health and
substance abuse services.
This ISP shall be developed and
implemented within 24 hours of
admission to address immediate
service, health, and safety needs
and shall continue in effect until
the ISP is developed or the
individual is discharged, whichever
comes first.
 
26
 
#15  Dated signature of the LMHP, LMHP-
R, LMHP-RP or LMHP-S.
 
DMAS
 
Who completed the
Comprehensive Needs
Assessment.
 
DBHDS
 
12VAC35-105-590.C.4:  Supervision shall
include responsibility for approving
assessments and individualized services
plans, as appropriate. This responsibility
may be delegated to an employee or
contractor who meets the qualification for
supervision as defined in this section.
 
12VAC35-105-590.C.5:  Supervision of
mental health, substance abuse, or co-
occurring services that are of an acute or
clinical nature such as outpatient, inpatient,
intensive in-home, or day treatment shall be
provided by a licensed mental health
professional or a mental health professional
who is license-eligible and registered with a
board of the Department of Health
Professions.
 
27
 
Comprehensive Needs Assessment
 
A DBHDS licensed agency may use a Psychiatric
Diagnostic Interview (90791, 90792) completed
by a LMHP, LMHP-R, LMHP-RP or LMHP-S (who
is employed or contracted by the same agency)
as the Comprehensive Needs Assessment.
All 15 required elements for the Comprehensive
Needs Assessment shall be included.
The practitioner/agency conducting the
Psychiatric Diagnostic Interview must be
credentialed with Magellan of VA or the MCO to
bill for CPT Codes 90791/90792.
 
28
 
Psychiatric Diagnostic Interview
 
Comprehensive Needs Assessment
 
If not all 15 required elements are included in the
Psychiatric Diagnostic Interview, a LMHP,
LMHP-R, LMHP-RP or LMHP-S may create an
addendum to address any of the missing
elements required for a Comprehensive Needs
Assessment to recommend CMHRS services.
 
Providers shall not bill for this addendum to the
Psychiatric Diagnostic Interview.
 
29
 
Psychiatric Diagnostic Interview
 
Comprehensive Needs Assessment
 
A psychiatrist, Dr. Captain America, employed
by the CSB conducts a psychiatric diagnostic
interview on John, a 53 year old male seen
through same day access.
 
 
30
 
Psychiatric Diagnostic Interview – Example #3
 
Dr. America recommends MHSS for John.  The CSB
may use the psychiatric diagnostic interview as a
Comprehensive Needs Assessment for MHSS if all 15
required elements are included.
 
The CPT code for the psychiatric diagnostic interview
shall be billed.
 
Comprehensive Needs Assessment
 
A psychiatrist, Doctor Strange, contracted by a CSB
conducts the psychiatric diagnostic interview on
Sally, age 35, and did not include all 15 elements
required for the Comprehensive Needs Assessment.
 
 
31
 
Psychiatric Diagnostic Interview – Example #4
 
Black Widow, who is an LMHP-RP and is employed with
the same CSB,  determines Sally could benefit for
MHSS.  Black Widow completes an addendum using the
psychiatric diagnostic interview and addressing the
additional elements to support the need for the
recommendation of MHSS.
 
The CSB would bill for the psychiatric diagnostic interview
but not for the addendum.
 
Comprehensive Needs Assessment
 
When the initial Comprehensive Needs Assessment
recommends several CMHRS services for an
individual, the provider shall use this assessment for
all CMHRS services recommended within the same
DBHDS licensed agency.
If additional service needs are identified after the
completion of the initial Comprehensive Needs
Assessment, the provider shall create an addendum
to the initial Comprehensive Needs Assessment.
 
32
 
Multiple Services Provided by the Same Agency
 
Comprehensive Needs Assessment
 
Providers shall bill for only one Comprehensive
Needs Assessment when these services are provided
by the same agency.
The provider shall bill the most appropriate
assessment code, and if recommending more than
one service, may choose the higher reimbursed
assessment code of the services that are being
recommended.
 
33
 
Multiple Services Provided by the Same Agency
 
Comprehensive Needs Assessment
 
If the provider later amends the Comprehensive
Needs Assessment due to the changing treatment
needs of the individual, the addendum to the
Comprehensive Needs Assessment is not billable
under an assessment code.
 
Remember, 
face-to-face
 time to conduct a
reassessment for purposes of completing an
addendum to the assessment is billable as part of
the service unit.  Providers shall also update the ISP
using this reassessment.
 
34
 
Multiple Services Provided by the Same Agency
 
Comprehensive Needs Assessment
 
Example #5
Provider Iron Man is recommending IIH
and TDT in the initial Comprehensive
Needs Assessment for Judy, age 8.
 
35
 
Multiple Services Provided by the Same Agency
 
Provider Iron Man shall bill only one assessment
code and may choose the higher reimbursement of
the two:  IIH Assessment/H0031 at $60.00.
 
The billing code and reimbursement rate must
follow the DMAS rate schedule.
 
Comprehensive Needs Assessment
 
Example #6
Provider Superman performs the
initial Comprehensive Needs
Assessment for Joshua, age 10, and
recommends TDT only.
 
36
 
Multiple Services Provided by the Same Agency
 
Provider Superman would bill the TDT Assessment
(H0032 U7) at $36.53.
 
Comprehensive Needs Assessment
 
Example #7
Provider Superman  provided TDT and later amends the
Comprehensive Needs Assessment for Joshua, as his needs
have changed. The addendum  includes a recommendation
to add IIH.
 
This is allowed because the addendum is within one year
from the date of the Comprehensive Needs Assessment.
 
Provider Superman would not bill for this addendum through
the IIH assessment code but could bill for the reassessment
under the TDT service hours as long as it is completed face-
to-face.  After completing the addendum, the provider shall
submit the service authorization request for IIH to Joshua's
MCO or Magellan of Virginia.
 
37
 
Multiple Services Provided by the Same Agency
 
Comprehensive Needs Assessment
 
In example #1, the SSPI for Tim which recommended IIH
was completed in December 2018.  In April 2019,
Provider Black Panther determines Tim meets medical
necessity for and would benefit from TDT.
Provider Black Panther shall create an initial
Comprehensive Needs Assessment that supports the
need for TDT and add IIH.
Provider Black Panther may bill for either IIH or TDT
assessment.
The annual reassessment is not due until April 2020.
 
38
 
Multiple Services Provided by the Same Agency
 
Comprehensive Needs Assessment
 
When coordinating services with another DBHDS
licensed agency, providers should share assessments
with appropriate consent from the member;
however, the agency receiving the referral shall
complete and bill for a new Comprehensive Needs
Assessment for the service they are to provide.
 
39
 
Multiple Services Provided by Different Agencies
 
Comprehensive Needs Assessment
 
Example #8
If Provider Thor is recommending MHSS and PSR
in the initial Comprehensive Needs Assessment
for Jack, age 47, but is only licensed to provide
MHSS.  Provider Thor shall bill the MHSS
Assessment code/H0032 U8.
 
40
 
Multiple Services Provided by Different Agencies
 
Provider Thor would refer the individual to Provider Loki who
is licensed to provide PSR.
 
Provider Loki would conduct a new Comprehensive
Needs Assessment with Jack, documenting medical
necessity for services and bill for the PSR
Assessment/H0032 U6.
 
Comprehensive Needs Assessment
 
Providers should only bill under the assessment code
for a service that they will be providing.
 
In the example on the previous slide, if Provider Thor
is licensed to provide both MHSS and PSR but will
only be providing MHSS, the assessment should be
billed under the MHSS assessment code and not
under the PSR assessment code.
 
41
 
Multiple Services Provided by Different Agencies
 
Comprehensive Needs Assessment
 
Example #9
If Dr. Thanos, a psychiatrist in a private practice, conducts
the psychiatric diagnostic interview for Erin, age 23, and
determines that Erin could benefit from MHSS and he needs
to initiate a referral to Provider Hawkeye, that is licensed by
DBHDS to provide MHSS.
 
42
 
Multiple Services Provided by Different Agencies
 
A LMHP, LMHP-R, LMHP-RP or LMHP-S employed or
contracted by Provider Hawkeye would need to conduct a
Comprehensive Needs Assessment to support the need for
Erin to receive MHSS.
 
In this case, Dr. Thanos would bill for the psychiatric diagnostic
interview and Provider Hawkeye would bill for the comprehensive
needs assessment.
 
Comprehensive Needs Assessment
 
Intensive In-Home Services (IIH)
Psychosocial Rehabilitation (PSR)
Therapeutic Day Treatment (TDT)
Day Treatment/Partial Hospitalization
Mental Health Skill-Building (MHSS)
Intensive Community Treatment (ICT)
    
(continued)
 
43
 
Services that can be Included as Part of a
Comprehensive Needs Assessment
 
Comprehensive Needs Assessment
 
Crisis Stabilization  *
Crisis Intervention  *
 
* A Certified Pre-screener who is not a LMHP, LMHP-R,
LMHP-RP or LMHP-S may conduct the assessment for
crisis services only. This assessment shall not be used as a
Comprehensive Needs Assessment or amended by a
LMHP, LMHP-R, LMHP-RP or LMHP-S to be used as a
Comprehensive Needs Assessment.
     
(continued)
 
 
 
44
 
Services that can be Included as Part of a
Comprehensive Needs Assessment
 
Comprehensive Needs Assessment
 
Mental Health Case Management*
 
*  A qualified mental health case manager who is not a LMHP,
LMHP-R, LMHP-RP or LMHP-S may conduct the assessment for
mental health case management only.  These assessments are
billed as part of the first month of  mental health case
management services (H0023).
An assessment completed by a qualified mental health case
manager who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S
may not be used as a Comprehensive Needs Assessment or
amended by a LMHP, LMHP-R, LMHP-RP or LMHP-S to be used
as a Comprehensive Needs Assessment.
 
45
 
Services that can be Included as Part of a
Comprehensive Needs Assessment
 
Comprehensive Needs Assessment
 
Example #10
Shuri, a qualified mental health case manager who is a
LMHP–S conducts the assessment for mental health
case management for Sarah, age 14.  During the
assessment, Shuri determines that Sarah could benefit
from IIH as well.  Shuri shall use this assessment as a
Comprehensive Needs Assessment because she
addressed all required 15 elements.
 
46
 
Services that can be Included as Part of a
Comprehensive Needs Assessment
 
Shuri may bill for the IIH Assessment (H0031).  At the end of
the month, she may also bill the monthly mental health case
management services as long as the case management
activities are met for billing.
 
Comprehensive Needs Assessment
 
The services listed below require program specific
assessments and may not be used as part of a
Comprehensive Needs Assessment
Substance Use Case Management
Treatment Foster Care Case Management
 Governor’s Access Pan (GAP) Case Management
Behavioral Therapy
Addiction and Recovery Treatment Services
Peer Support Services
 
47
 
Services that Cannot be Included as Part of a
Comprehensive Needs Assessment
 
Comprehensive Needs Assessment
 
At a minimum, the addendum must:
Clearly document the medical necessity for the additional
service.
Become part of the Comprehensive Needs Assessment and be
accessible in the member’s medical record.
Be signed and dated by the LMHP, LMHP-R, LMHP-RP or
LMHP-S conducting the assessment.
 
The addendum is valid as long as the Comprehensive Needs
Assessment is current.  The Comprehensive Needs Assessment is
considered outdated if more than 12 months old.
 
The ISP shall be updated to reflect any changes in the individual’s
needs.
 
 
48
 
Addendum Requirements
 
Comprehensive Needs Assessment
 
The initial Comprehensive Needs Assessment
(including any addendums to the assessment) is valid
for one year from the date of the initial assessment.
When providers create a Comprehensive Needs
Assessment to replace an outdated SSPI, they may
choose to use the Comprehensive Needs Assessment
to update the assessments for all services they
provide, even if the SSPIs for the other services are
still valid.
The ISP shall continued to be reviewed quarterly (90
calendar days), updated annually, and as the needs,
goals and progress of the individual changes.
Providers may choose to align ISP reviews if improves
workflow processes.
 
49
 
Reassessments
 
Comprehensive Needs Assessment
 
Example #11
Provider Winter Soldier completed Tim’s SSPI for
IIH in December 8, 2018.  Provider Winter Soldier
completed a Comprehensive Needs Assessment
for Tim and recommended TDT on April 20,
2019.
 
50
 
Reassessments
 
Since Provider Winter Soldier is providing both IIH and TDT,
they shall include IIH in the Comprehensive Needs
Assessment conducted on April 20, 2019 to recommend
TDT.  Thus, the annual reassessment for IIH and TDT would
not be due until April 19, 2020, unless Tim’s needs change.
 
Comprehensive Needs Assessment
 
If CMHRS services* are not initiated within 31 calendar days
from the date they are recommended by a LMHP, LMHP-R,
LMHP-RP or LMHP-S, the Comprehensive Needs Assessment
needs to be amended or updated prior to initiating services.
Please note that services should start as soon as possible after
the initial assessment. Crisis intervention and crisis stabilization
services require immediate service delivery and it is not
appropriate to have a delay of up to 31 days to initiate the
service.
 
*does not apply to mental health case management
 
51
 
Reassessments
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessment must be updated
when there is a clinical indication based on the medical,
psychiatric or behavioral symptoms of the individual.
This can be done through an addendum as well as
reflected in an updated ISP.
Individuals experiencing an acute psychiatric crisis shall
have a new Comprehensive Needs Assessment in order
to recommend Crisis Intervention or Crisis Stabilization.
Include the previously received services, such as MHSS,
within this assessment for Crisis services if they remain
appropriate.
 
52
 
Reassessments
 
Comprehensive Needs Assessment
 
At a minimum, the Comprehensive Needs Assessment
must be reviewed annually by a LMHP, LMHP-R, LMHP-
RP or LMHP-S.
Reviews must be documented in a progress note or on
the assessment by the LMHP, LMHP-R, LMHP-RP or
LMHP-S and are not billable.
MHSS and PSR require that the service be reviewed
every six months to determine if it continues to be
appropriate for the individual.  This may be performed
through an addendum or documented in the progress
notes.
 
53
 
Reassessments
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessment must also be
updated when there is a lapse in all CMHRS services
provided by the same agency for greater than 31
consecutive calendar days.  These reassessments are
billable using the guidelines in the November 20, 2018
memo.
Mental Health Case Management has different
guidelines for lapse in services.  Providers should follow
DBHDS guidance for lapse in Mental Health Case
Management services.
 
54
 
Reassessments – Lapse in Services
 
Comprehensive Needs Assessment
 
If there is a lapse of greater than 31 days in one but not
all CMHRS services* that an agency provides to an
individual, the LMHP, LMHP-R, LMHP-RP or LMHP-S
may make an addendum to the current Comprehensive
Needs Assessment explaining the lapse and providing
justification for continued services.
The addendum is not billable.
 
* does not apply to mental health case management, crisis stabilization or
crisis intervention.  Providers should refer to DBHDS guidance for
assessment requirements for these services.
 
55
 
Reassessments – Lapse in Services
 
Comprehensive Needs Assessment
 
Example #12
Tim receives IIH and school based TDT from Provider Captain
America.
 
Tim did not need TDT services during the summer and had a
lapse for greater than 31 days. Provider Captain American
continued to provide IIH during the summer.
 
Provider Captain America shall complete an addendum to the
Comprehensive Needs Assessment prior to resuming school-
based TDT in the fall which justifies the need for TDT during
the school year based on Tim’s current needs.
 
The addendum is not billable.
 
56
 
Reassessments – Lapse in Services
 
Comprehensive Needs Assessment
 
Example #13
Jody received school based TDT and IIH from different
providers and she did not require TDT services over the
summer break.  Thus she had a  lapse of TDT for greater
than 31 days.
 
Jody’s TDT provider must conduct a new Comprehensive
Needs Assessment prior to resuming TDT in the fall
which justifies the need for TDT based on her current
needs.
 
57
 
Reassessments – Lapse in Services
 
Comprehensive Needs Assessment
 
Example #14
Joshua has been receiving MHSS from Provider X-
Men that were based on SSPI prior to January 1,
2019.  Joshua experiences an acute psychiatric crisis
February 5, 2019.
 
58
 
Reassessments and Crisis Services
 
He receives crisis intervention services by Provider X-Men who is licensed
to provide both MHSS and Crisis Intervention. Provider X-Men would
perform an initial Comprehensive Needs Assessment to support the need
for Crisis Intervention services since the individual is experiencing acute
psychiatric symptoms.
 
Provider X-Men may incorporate MHSS in the Comprehensive Needs
Assessment to support the ongoing need for these services.  The
assessment for MHSS will then be valid through February 4, 2020.
 
Comprehensive Needs Assessment
 
 
MCOs/Magellan of Virginia may request that copies of
Comprehensive Needs Assessments and Addendums
be submitted with service authorization requests.
 
 
59
 
Service Authorization
 
Comprehensive Needs Assessment
 
A Comprehensive Needs Assessment shall be
required prior to developing an Individual Services
Plan (ISP) and shall be required as a reference point
for the ISP during the entire duration of services.
Services based upon incomplete, missing, or
outdated (more than a year old or not reflective of
the individual’s current level of need)
Comprehensive Needs Assessments/re-
assessments and ISPs shall be denied
reimbursement.
 
60
 
Utilization Review
 
Comprehensive Needs Assessment
 
The Comprehensive Needs Assessments must be
completed face-to-face by an LMHP, LMHP-S,
LMHP-R, or LMHP-RP.
Comprehensive Needs Assessments must be
completed prior to initiating services in accordance
with each service’s specific licensing requirements.
 
 
61
 
Utilization Review
 
Comprehensive Needs Assessment
 
Comprehensive Needs Assessments must contain a
documented history of the severity, intensity, and
duration of mental health care problems and issues
and shall contain all fifteen elements to qualify for
reimbursement. The Comprehensive Needs
Assessment shall document the medical necessity
criteria and how service needs match the level of
care criteria.
 
 
62
 
Utilization Review
 
Comprehensive Needs Assessment
 
Comprehensive Needs Assessments must address
all 15 required elements and support medical
necessity criteria as presented in the service
authorization and the most current ISP.
 
Comprehensive Needs Assessments and ISPs must
be up to date based on the clinical and service needs
of the individual.
 
 
63
 
Utilization Review
 
Comprehensive Needs Assessment
 
For obtaining a service authorization, the information
contained in the Comprehensive Needs Assessment
must be used to provide the information used to
determine the medically necessity for each service
requested on behalf of the individual.
 
The record must contain a preliminary working DSM
diagnosis and a Comprehensive Needs Assessment upon
which the diagnosis and ISP is based.
 
 
64
 
Utilization Review
 
Comprehensive Needs Assessment
 
Documentation must be present to justify the need
for additional Comprehensive Needs Assessments.
The Comprehensive Needs Assessment and any
addendums and reviews must be available in the
child’s medical record.
With appropriate consents, agencies shall make the
Comprehensive Needs Assessment accessible to all
necessary staff providing services to the member.
 
65
 
Utilization Review
 
Crisis Stabilization
 
DMAS recommends that an individual eligible for
crisis stabilization services receive a
psychiatric/medical evaluation within 72 hours of
admission to the service.
The purpose of a psychiatric/medical evaluation
during initiation of crisis stabilization services is to
address medical and pharmacological interventions
that may help to support the individual with
managing their acute symptoms in the least
restrictive environment.
 
66
 
Psychiatric Evaluations
 
Crisis Stabilization
 
Crisis Stabilization providers do not need to
discharge individuals if they are not seen by a
psychiatrist, nurse practitioner or physician assistant
within 72 hours of service admission.
Providers should document attempts and any
barriers to coordinating a psychiatric/medical
evaluation for the individual, or the reasons why it
would not be in the individual’s best interest to meet
with a psychiatrist, nurse practitioner or physician
assistant during this treatment period.
 
67
 
Psychiatric Evaluation cont.
 
Crisis Stabilization
 
DMAS is expanding the practitioner type to allow for
physicians, nurse practitioners and physician assistants
acting within the scope of their practice in accordance
with the applicable Virginia Health Regulatory Board.
The evaluation does not have to be performed by the
Crisis Stabilization provider and may be coordinated
with a private provider.
DMAS does not require the evaluation to be billed nor
does the provider have to be enrolled as a Medicaid
provider, including an ordering, prescribing or referring
(ORP) practitioner.
 
 
68
 
Providers Performing the Psychiatric Evaluation
 
Crisis Stabilization
 
A face-to-face evaluation is recommended,
however, if coordinated with an outpatient provider,
the evaluation may be conducted through
telemedicine as allowed in physician and outpatient
psychiatric services.
See the 
DMAS Physician Manual 
and
 Psychiatric
Service Manual
 for additional details.  Telemedicine
is not allowed for services billed under Crisis
Stabilization.
 
69
 
Psychiatric Evaluation and Telemedicine
 
Crisis Stabilization
 
If the evaluation is to be billed and reimbursed through a
Medicaid MCO or Magellan of Virginia under physician
or outpatient psychiatric services, the provider must
either be credentialed with the appropriate MCO or
Magellan of Virginia or be employed by an agency
credentialed with the appropriate MCO or Magellan of
Virginia.
Magellan of Virginia only credentials providers of
behavioral health services.
Providers shall consult with the MCO or Magellan of
Virginia for credentialing questions prior to providing
services to ensure they meet qualifications for
reimbursement.
 
70
 
Billing the Psychiatric Evaluation
 
At Risk of Physical Injury Form
 
The At Risk of Physical Injury form (P502) form is no
longer required in Therapeutic Day Treatment (TDT)
and Intensive In-Home (IIH) Services.  References to the
form will be removed from the manual and the
Magellan of Virginia website.
 
71
 
At Risk of Physical Injury Form (P502)
 
Questions?
 
72
 
DMAS Contracted Health Plans
 
73
 
M4 and CCC Plus
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Review the recent changes to the CMHRS Provider Manual, including the implementation of the Comprehensive Needs Assessment effective January 1, 2019, clarification on psychiatric evaluation in Crisis Stabilization services, and the removal of the At Risk of Physical Injury form requirement in Therapeutic Day Treatment and Intensive In-Home services. The Comprehensive Needs Assessment aims to streamline the assessment process, enhance efficiency, and improve access to care for individuals receiving CMHRS services. Providers must adhere to the guidelines outlined in the CMHRS Medicaid Memo dated November 20, 2018, when conducting assessments for new service requests or outdated recommendations. Examples of assessments scenarios are provided to illustrate the application of these changes in practice.


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  1. UPDATES TO COMMUNITY MENTAL HEALTH REHABILITATIVE SERVICES (CMHRS) Developmental Disabilities and Behavioral Health Unit Virginia Department of Medical Assistance Services

  2. Agenda Reviewing the most recent CMHRS Medicaid Memo that reflects changes to the CMHRS Provider Manual to include the following: Implementing the Comprehensive Needs Assessment (effective January 1, 2019); Clarifying the recommendation for a psychiatric evaluation in Crisis Stabilization services; and Removing the At Risk of Physical Injury form (P502) requirement in Therapeutic Day Treatment (TDT) and Intensive In-Home (IIH) Services. Special recognition of participants in the development of the memo and presentation. 2

  3. Comprehensive Needs Assessment Effective January 1, 2019 DMAS is implementing the Comprehensive Needs Assessment in CMHRS to allow for a single assessment to be used when recommending one or more CMHRS services provided by the same Department of Behavioral Health and Developmental Services (DBHDS) licensed agency. Allowing one Comprehensive Needs Assessment in place of multiple Service-Specific Provider Intakes (SSPIs) is intended to support efficiency and access to care by reducing the time and administrative burden on providers and members they serve. 3

  4. Comprehensive Needs Assessment Effective January 1, 2019 A Comprehensive Needs Assessment that follows the guidelines in the CMHRS Medicaid Memo dated November 20, 2018, is required for new requests for CMHRS services and for CMHRS services previously recommended by a SSPI that is outdated (greater than 12 months old). SSPIs and Psychiatric Diagnostic Interviews completed prior to January 1, 2019 will not apply to the Comprehensive Needs Assessment criteria. 4

  5. Comprehensive Needs Assessment Example #1 Provider Black Panther performs an Intensive In-home (IIH) SSPI for Tim, a 13 year old, on 12/7/18. However Provider Black Panther does not initiate services until 1/4/2019. The SSPI would be valid for IIH through 12/6/19. Provider Black Panther would not have to update the assessment as part of a Comprehensive Needs Assessment until 12/7/19 unless services lapse for more than 31 days or Tim s needs change. 5

  6. Comprehensive Needs Assessment Example #2 In April 2019, Tim s needs change and he requires school based TDT in addition to IIH. Provider Black Panther is also licensed for TDT. Since the assessment used for Tim s IIH is a SSPI, it can not be used as a Comprehensive Needs Assessment. Provider Black Panther will have to conduct a new Comprehensive Needs Assessment for TDT. 6

  7. Comprehensive Needs Assessment Agency Definition Licensed agencies include providers with a specific DBHDS license to provide one or more of the following services: Intensive In-Home Services (IIH) Psychosocial Rehabilitation (PSR) Therapeutic Day Treatment (TDT) Day Treatment/Partial Hospitalization Mental Health Skill-Building (MHSS) Intensive Community Treatment (ICT) Crisis Stabilization Crisis Intervention Mental Health Case Management 7

  8. Comprehensive Needs Assessment Professionals Conducting the Assessment The Comprehensive Needs Assessment, including all addendums, shall be conducted and documented by a: Licensed Mental Health Professional (LMHP); LMHP-Resident (LMHP-R); LMHP-Supervisee (LMHP-S); or LMHP Resident in Psychology (LMHP-RP). 8

  9. Comprehensive Needs Assessment Assessments and Reassessments Means the face-to-face interaction in which the provider obtains information from the individual, and parent, guardian, or other family member or members, as appropriate, about the individual s mental health status. It includes documented history of the severity, intensity, and duration of mental health problems and behavioral and emotional issues. 9

  10. Comprehensive Needs Assessment Requirements The Comprehensive Needs Assessment must: Document the medical necessity for each recommended CMHRS service (including mental health case management) provided by the agency; Be face-to-face with the member and appropriate family members, guardians, or member representative; and Include all 15 elements previously required of the SSPI. 10

  11. Comprehensive Needs Assessment Requirements (continued) The Comprehensive Needs Assessment is required prior to the development of the Individual Service Plan (ISP) for each service and is used as the basis for the ISP for the entire duration of services. All providers shall ensure they meet the DMAS requirements as well as the DBHDS licensing requirements for completion of assessments. 11

  12. DMAS Billing Requirements for the Comprehensive Needs Assessment (15 Elements) vs DBHDS Licensing Requirements

  13. #1 Presenting Issue(s)/Reason for Referral: Chief Complaint DMAS DBHDS* Indicate duration, frequency and severity of behavioral health symptoms. Identify precipitating events/stressors, relevant history.) If a child is at risk of an out of home placement, state the specific reason and what the out-of- home placement may be. Presenting needs including the individual's stated needs, psychiatric needs, support needs, and the onset and duration of problems; Onset and duration of problems *Italicized and Underlined = Initial Assessment Requirements Bold = items DBHDS requires that are not required by DMAS, list is not inclusive of all differences. Providers are responsible for ensuring compliance with DBHDS requirements. 13

  14. #2 Behavioral Health History/Hospitalizations: DMAS DBHDS Give details of mental health history and any mental health related hospitalizations and diagnoses. List family members and the dates and the types of mental health treatment that family members either are currently receiving or have received in the past. Previous interventions and outcomes; diagnosis 14

  15. #3 Previous Interventions by providers and timeframes and response to treatment: DMAS DBHDS include the types of interventions that have been provided to the individual. Include the date of the mental health interventions and the name of the mental health provider. Previous interventions and outcomes 15

  16. #4 Medical Profile: DMAS DBHDS Describe significant past and present medical problems, illnesses and injuries, known allergies, current physical complaints and medications. As needed, conduct an individualized fall risk assessment to indicate whether the individual has any physical conditions or other impairments that put her or him at risk for falling. All children aged 10 years or younger should be assessed for fall risks based on age-specific norms. Current Medical problems Current medications As applicable, and in all residential services, fall risk, communication methods or needs, and mobility and adaptive equipment needs. Health history and current medical care needs, to include: Allergies; Recent physical complaints and medical conditions; Nutritional needs; Chronic conditions; Communicable diseases; Restrictions on physical activities if any; Restrictive protocols or special supervision requirements; Past serious illnesses, serious injuries, and hospitalizations; Serious illnesses and chronic conditions of the individual's parents, siblings, and significant others in the same household; and Current and past substance use including alcohol, prescription and nonprescription medications, and illicit drugs 16

  17. #5 Developmental History: DMAS DBHDS Social, behavioral, developmental, and family history and supports; Describe the individual as an infant and as a toddler: individual s typical affect and level of irritability; medical/physical complications/illnesses; interest in being held, fed, played with and the parent s ability to provide these; parent s feelings/thoughts about individual as an infant and toddler. Was the individual significantly delayed in reaching any developmental milestones, if so, describe. Were there any significant complications at birth? History of abuse, neglect, sexual, or domestic violence, or trauma including psychological trauma; cognitive functioning including strengths and weaknesses 17

  18. #6 Educational/Vocational Status: DMAS DBHDS School, grade, special education/IEP status, academic performance, behaviors, suspensions/expulsions, any changes in academic functioning related to stressors, tardiness/attendance, and peer relationships. Financial resources and benefits Employment, vocational, and educational background 18

  19. #7 Current Living Situation, Family History and Relationships: DMAS DBHDS Describe the daily routine and structure, housing arrangements, financial resources and benefits. Significant family history including family conflicts, relationships and interactions affecting the individual and family's functioning should be listed along with a list of all family or household members. Social, behavioral, developmental, and family history and supports; Housing arrangements; 19

  20. #8 Legal Status: Indicate individuals criminal justice status: DMAS DBHDS Pending charges, court hearing date, probation status, past convictions, current probation violations, past incarcerations. Legal status including authorized representative, commitment, and representative payee status; Relevant criminal charges or convictions and probation or parole status; 20

  21. #9 Drug and Alcohol Profile: DMAS DBHDS Current and past substance use including alcohol, prescription and nonprescription medications, and illicit drugs Psychiatric and substance use issues including current mental health or substance use needs, presence of co-occurring disorders, history of substance use or abuse, and circumstances that increase the individual's risk for mental health or substance use issues; Describe substance use by the individual and/or family members; specify the type of substance with frequency and duration of usage. Include any treatment or other recovery related efforts. 21

  22. #10 Resources and Strengths: DMAS DBHDS Document individual s strengths, preferences, extracurricular, community and social activities, extended family; activities that the individual engages in or are meaningful to the individual. These elements are key to developing an ISP that supports the individual s recovery and resiliency efforts and goals. Daily living skill Ability to access services including transportation needs 22

  23. #11 Mental Status Profile: DMAS DBHDS Include findings and clinical tools used. At-risk behavior to self and others. 23

  24. #12 Diagnosis: DMAS DBHDS The documentation of a diagnosis must include the DSM diagnostic code & description as documented by the LMHP that provided the diagnosis. Diagnosis Cognitive functioning including strengths and weaknesses; 24

  25. #13 Professional Comprehensive Needs Assessment Summary and Clinical Formulation: DMAS Includes a documentation of medically necessary services as defined by the service provider which: Identifies as much as possible, the causes of presenting treatment issues, and Identifies and discusses treatment options, outcomes, and potential barriers to progress, so that an individual specific service plan can be developed. DBHDS Psychiatric and substance use issues including current mental health or substance use needs, presence of co-occurring disorders, history of substance use or abuse, and circumstances that increase the individual's risk for mental health or substance use issues Onset and duration of problems Presenting needs including the individual's stated needs, psychiatric needs, support needs, and the onset and duration of problems; 12VAC35-105-660.B : The provider shall develop an initial person-centered ISP for the first 60 days for mental retardation (intellectual disability) and developmental disabilities services or for the first 30 days for mental health and substance abuse services. This ISP shall be developed and implemented within 24 hours of admission to address immediate service, health, and safety needs and shall continue in effect until the ISP is developed or the individual is discharged, whichever comes first. 25

  26. #14 Recommended Care and Treatment Goals DMAS DBHDS 12VAC35-105-660.B : The provider shall develop an initial person- centered ISP for the first 60 days for mental retardation (intellectual disability) and developmental disabilities services or for the first 30 days for mental health and substance abuse services. This ISP shall be developed and implemented within 24 hours of admission to address immediate service, health, and safety needs and shall continue in effect until the ISP is developed or the individual is discharged, whichever comes first. To build the ISP 26

  27. #15 Dated signature of the LMHP, LMHP- R, LMHP-RP or LMHP-S. DMAS DBHDS 12VAC35-105-590.C.4: Supervision shall include responsibility for approving assessments and individualized services plans, as appropriate. This responsibility may be delegated to an employee or contractor who meets the qualification for supervision as defined in this section. Who completed the Comprehensive Needs Assessment. 12VAC35-105-590.C.5: Supervision of mental health, substance abuse, or co- occurring services that are of an acute or clinical nature such as outpatient, inpatient, intensive in-home, or day treatment shall be provided by a licensed mental health professional or a mental health professional who is license-eligible and registered with a board of the Department of Health Professions. 27

  28. Comprehensive Needs Assessment Psychiatric Diagnostic Interview A DBHDS licensed agency may use a Psychiatric Diagnostic Interview (90791, 90792) completed by a LMHP, LMHP-R, LMHP-RP or LMHP-S (who is employed or contracted by the same agency) as the Comprehensive Needs Assessment. All 15 required elements for the Comprehensive Needs Assessment shall be included. The practitioner/agency conducting the Psychiatric Diagnostic Interview must be credentialed with Magellan of VA or the MCO to bill for CPT Codes 90791/90792. 28

  29. Comprehensive Needs Assessment Psychiatric Diagnostic Interview If not all 15 required elements are included in the Psychiatric Diagnostic Interview, a LMHP, LMHP-R, LMHP-RP or LMHP-S may create an addendum to address any of the missing elements required for a Comprehensive Needs Assessment to recommend CMHRS services. Providers shall not bill for this addendum to the Psychiatric Diagnostic Interview. 29

  30. Comprehensive Needs Assessment Psychiatric Diagnostic Interview Example #3 A psychiatrist, Dr. Captain America, employed by the CSB conducts a psychiatric diagnostic interview on John, a 53 year old male seen through same day access. Dr. America recommends MHSS for John. The CSB may use the psychiatric diagnostic interview as a Comprehensive Needs Assessment for MHSS if all 15 required elements are included. The CPT code for the psychiatric diagnostic interview shall be billed. 30

  31. Comprehensive Needs Assessment Psychiatric Diagnostic Interview Example #4 A psychiatrist, Doctor Strange, contracted by a CSB conducts the psychiatric diagnostic interview on Sally, age 35, and did not include all 15 elements required for the Comprehensive Needs Assessment. Black Widow, who is an LMHP-RP and is employed with the same CSB, determines Sally could benefit for MHSS. Black Widow completes an addendum using the psychiatric diagnostic interview and addressing the additional elements to support the need for the recommendation of MHSS. The CSB would bill for the psychiatric diagnostic interview but not for the addendum. 31

  32. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency When the initial Comprehensive Needs Assessment recommends several CMHRS services for an individual, the provider shall use this assessment for all CMHRS services recommended within the same DBHDS licensed agency. If additional service needs are identified after the completion of the initial Comprehensive Needs Assessment, the provider shall create an addendum to the initial Comprehensive Needs Assessment. 32

  33. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency Providers shall bill for only one Comprehensive Needs Assessment when these services are provided by the same agency. The provider shall bill the most appropriate assessment code, and if recommending more than one service, may choose the higher reimbursed assessment code of the services that are being recommended. 33

  34. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency If the provider later amends the Comprehensive Needs Assessment due to the changing treatment needs of the individual, the addendum to the Comprehensive Needs Assessment is not billable under an assessment code. Remember, face-to-face time to conduct a reassessment for purposes of completing an addendum to the assessment is billable as part of the service unit. Providers shall also update the ISP using this reassessment. 34

  35. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency Example #5 Provider Iron Man is recommending IIH and TDT in the initial Comprehensive Needs Assessment for Judy, age 8. Provider Iron Man shall bill only one assessment code and may choose the higher reimbursement of the two: IIH Assessment/H0031 at $60.00. The billing code and reimbursement rate must follow the DMAS rate schedule. 35

  36. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency Example #6 Provider Superman performs the initial Comprehensive Needs Assessment for Joshua, age 10, and recommends TDT only. Provider Superman would bill the TDT Assessment (H0032 U7) at $36.53. 36

  37. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency Example #7 Provider Superman provided TDT and later amends the Comprehensive Needs Assessment for Joshua, as his needs have changed. The addendum includes a recommendation to add IIH. This is allowed because the addendum is within one year from the date of the Comprehensive Needs Assessment. Provider Superman would not bill for this addendum through the IIH assessment code but could bill for the reassessment under the TDT service hours as long as it is completed face- to-face. After completing the addendum, the provider shall submit the service authorization request for IIH to Joshua's MCO or Magellan of Virginia. 37

  38. Comprehensive Needs Assessment Multiple Services Provided by the Same Agency In example #1, the SSPI for Tim which recommended IIH was completed in December 2018. In April 2019, Provider Black Panther determines Tim meets medical necessity for and would benefit from TDT. Provider Black Panther shall create an initial Comprehensive Needs Assessment that supports the need for TDT and add IIH. Provider Black Panther may bill for either IIH or TDT assessment. The annual reassessment is not due until April 2020. 38

  39. Comprehensive Needs Assessment Multiple Services Provided by Different Agencies When coordinating services with another DBHDS licensed agency, providers should share assessments with appropriate consent from the member; however, the agency receiving the referral shall complete and bill for a new Comprehensive Needs Assessment for the service they are to provide. 39

  40. Comprehensive Needs Assessment Multiple Services Provided by Different Agencies Example #8 If Provider Thor is recommending MHSS and PSR in the initial Comprehensive Needs Assessment for Jack, age 47, but is only licensed to provide MHSS. Provider Thor shall bill the MHSS Assessment code/H0032 U8. Provider Thor would refer the individual to Provider Loki who is licensed to provide PSR. Provider Loki would conduct a new Comprehensive Needs Assessment with Jack, documenting medical necessity for services and bill for the PSR Assessment/H0032 U6. 40

  41. Comprehensive Needs Assessment Multiple Services Provided by Different Agencies Providers should only bill under the assessment code for a service that they will be providing. In the example on the previous slide, if Provider Thor is licensed to provide both MHSS and PSR but will only be providing MHSS, the assessment should be billed under the MHSS assessment code and not under the PSR assessment code. 41

  42. Comprehensive Needs Assessment Multiple Services Provided by Different Agencies Example #9 If Dr. Thanos, a psychiatrist in a private practice, conducts the psychiatric diagnostic interview for Erin, age 23, and determines that Erin could benefit from MHSS and he needs to initiate a referral to Provider Hawkeye, that is licensed by DBHDS to provide MHSS. A LMHP, LMHP-R, LMHP-RP or LMHP-S employed or contracted by Provider Hawkeye would need to conduct a Comprehensive Needs Assessment to support the need for Erin to receive MHSS. In this case, Dr. Thanos would bill for the psychiatric diagnostic interview and Provider Hawkeye would bill for the comprehensive needs assessment. 42

  43. Comprehensive Needs Assessment Services that can be Included as Part of a Comprehensive Needs Assessment Intensive In-Home Services (IIH) Psychosocial Rehabilitation (PSR) Therapeutic Day Treatment (TDT) Day Treatment/Partial Hospitalization Mental Health Skill-Building (MHSS) Intensive Community Treatment (ICT) (continued) 43

  44. Comprehensive Needs Assessment Services that can be Included as Part of a Comprehensive Needs Assessment Crisis Stabilization * Crisis Intervention * * A Certified Pre-screener who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S may conduct the assessment for crisis services only. This assessment shall not be used as a Comprehensive Needs Assessment or amended by a LMHP, LMHP-R, LMHP-RP or LMHP-S to be used as a Comprehensive Needs Assessment. (continued) 44

  45. Comprehensive Needs Assessment Services that can be Included as Part of a Comprehensive Needs Assessment Mental Health Case Management* * A qualified mental health case manager who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S may conduct the assessment for mental health case management only. These assessments are billed as part of the first month of mental health case management services (H0023). An assessment completed by a qualified mental health case manager who is not a LMHP, LMHP-R, LMHP-RP or LMHP-S may not be used as a Comprehensive Needs Assessment or amended by a LMHP, LMHP-R, LMHP-RP or LMHP-S to be used as a Comprehensive Needs Assessment. 45

  46. Comprehensive Needs Assessment Services that can be Included as Part of a Comprehensive Needs Assessment Example #10 Shuri, a qualified mental health case manager who is a LMHP S conducts the assessment for mental health case management for Sarah, age 14. During the assessment, Shuri determines that Sarah could benefit from IIH as well. Shuri shall use this assessment as a Comprehensive Needs Assessment because she addressed all required 15 elements. Shuri may bill for the IIH Assessment (H0031). At the end of the month, she may also bill the monthly mental health case management services as long as the case management activities are met for billing. 46

  47. Comprehensive Needs Assessment Services that Cannot be Included as Part of a Comprehensive Needs Assessment The services listed below require program specific assessments and may not be used as part of a Comprehensive Needs Assessment Substance Use Case Management Treatment Foster Care Case Management Governor s Access Pan (GAP) Case Management Behavioral Therapy Addiction and Recovery Treatment Services Peer Support Services 47

  48. Comprehensive Needs Assessment Addendum Requirements At a minimum, the addendum must: Clearly document the medical necessity for the additional service. Become part of the Comprehensive Needs Assessment and be accessible in the member s medical record. Be signed and dated by the LMHP, LMHP-R, LMHP-RP or LMHP-S conducting the assessment. The addendum is valid as long as the Comprehensive Needs Assessment is current. The Comprehensive Needs Assessment is considered outdated if more than 12 months old. The ISP shall be updated to reflect any changes in the individual s needs. 48

  49. Comprehensive Needs Assessment Reassessments The initial Comprehensive Needs Assessment (including any addendums to the assessment) is valid for one year from the date of the initial assessment. When providers create a Comprehensive Needs Assessment to replace an outdated SSPI, they may choose to use the Comprehensive Needs Assessment to update the assessments for all services they provide, even if the SSPIs for the other services are still valid. The ISP shall continued to be reviewed quarterly (90 calendar days), updated annually, and as the needs, goals and progress of the individual changes. Providers may choose to align ISP reviews if improves workflow processes. 49

  50. Comprehensive Needs Assessment Reassessments Example #11 Provider Winter Soldier completed Tim s SSPI for IIH in December 8, 2018. Provider Winter Soldier completed a Comprehensive Needs Assessment for Tim and recommended TDT on April 20, 2019. Since Provider Winter Soldier is providing both IIH and TDT, they shall include IIH in the Comprehensive Needs Assessment conducted on April 20, 2019 to recommend TDT. Thus, the annual reassessment for IIH and TDT would not be due until April 19, 2020, unless Tim s needs change. 50

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