Mental Health Services - Washington State Health Care ...

Washington Apple Health (Medicaid)

Mental Health Services Billing Guide

January 1, 2019

Every effort has been made to ensure this guide's accuracy. If an actual or apparent conflict between this document and an agency rule arises, the agency rules apply.

Mental Health Services

About this guide*

This publication takes effect January 1, 2019, and supersedes earlier guides to this program. HCA is committed to providing equal access to our services. If you need an accommodation or require documents in another format, please call 1-800-562-3022. People who have hearing or speech disabilities, please call 711 for relay services.

Washington Apple Health means the public health insurance programs for eligible Washington residents. Washington Apple Health is the name used in Washington State for Medicaid, the children's health insurance program (CHIP), and stateonly funded health care programs. Washington Apple Health is administered by the Washington State Health Care Authority.

2

Mental Health Services

What has changed?

Subject

How do providers identify the correct payer?

Change Revised information on the last two pages of the How do providers identify the correct payer? chart:

? Added "CCW" (Coordinated Care of Washington) under both outpatient mental health services and inpatient psychiatric services on the next to the last page of the chart.

Reason for Change

Correcting an error. This information was incorrectly omitted from the previous version of the guide. Correction made January 4, 2019.

? On the last page of the chart, added "enrolled with MCO's Behavioral Health Services Only (BHSO) program (or enrolled with regional BHO in non-integrated managed care region)" after FFS Apple Health client under the Apple Health (Medicaid) column. Also on the last page, added "Applicable MCO* (Client lives in a designated integrated managed care region)" under both outpatient mental health services and inpatient psychiatric services.

Client Eligibility: BHO, Changes for January 1, 2019, IMC, and Integrated Apple Health Foster Care

Effective January 1, 2019, some existing integrated managed care regions have new counties and many new regions and counties will be implemented.

Apple Health managed care organizations (MCOs) in certain RSAs will expand their coverage of behavioral health services (mental health and substance use disorder treatment), along with continuing to cover physical health services.

3

Mental Health Services

Subject Division of Behavioral Health and Recovery (DBHR)

Program Overview

Change Throughout this guide, removed references to the Division of Behavioral Health and Recovery (DBHR) and replaced with "the agency."

Simplify the descriptions of Part 1 and Part II of this guide. Describe new and existing services of the Partnership Access Line (PAL). Add note about health and behavior CPT codes 9615096155). Removed outdated information to Access to Care Standards.

Reason for Change

DBHR was relocated from the Department of Social and Health Services to the Health Care Authority on July 1, 2018 per House Bill 1388. Program updates, including two new PAL services

How do providers identify the correct payer?

Expedited Prior Authorization

Inpatient hospital psychiatric care criteria Children's LongTerm Inpatient Program (CLIP) Procedure codes for psychological assessments

Added BHO/BH-ASO to column about outpatient crisis intervention for mental health services. Added "Authorized by BHO and paid through ProviderOne if ITA" to column about inpatient psychiatric services, including ITA, in the community hospital setting. Made other housekeeping changes to entire table. Removed old Expedited Prior Authorization (EPA) codes and replaced with new codes.

Added that services provided in a psychiatric hospital must have psychiatric diagnosis and be in APR DRG 740-760. Added new phone number and fax number. Added "a copy of the minor's certified 180-day court order" to the list of required information. Replaced CPT codes for psychological assessments with multiple new CPT codes throughout the guide.

Integrated managed care implementation

The agency identified evidencebased practices that require additional EPAs for reporting purposes. Clarification

Housekeeping and clarification

New codes from the Centers for Medicare and Medicaid Services

4

Mental Health Services

Subject Wraparound with Intensive Services (WISe) Monthly Case Rate

Access to care standards (ACS)

Age of consent for voluntary inpatient hospital psychiatric care

Change Added HCPCS code T1041 for per month billing for Community Behavioral Health services for Wraparound with Intensive Services (WISe)

Removed references to access to care (ACS) standard and replaced with updated language on billing for high acuity or low acuity care. Added "through the Parent Initiated Treatment process" to the table in Part I and Part II.

Reason for Change New payment methodology for WISe, a Medicaidfunded range of services for children with mental disorders causing severe disruptions in behavior The statewide ACS are no longer in use.

Clarification

Recoupment of Payments

Procedure codes for Developmental Testing

Health and Behavior codes

Took information already in the guide and duplicated it in both Part I and Part II. Also added information about the A19 Invoice Voucher and other clarifying language. CPT codes for developmental testing are now 96112 and 96113

Added Health and Behavior code coverage

To increase usability

New codes from the Centers for Medicare and Medicaid Services Policy change

Neuropsychological Listed new CPT codes. Testing

New codes from the Centers for Medicare

5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download