OH – Medicaid Oversight Committees Announce Changes to State Behavioral Health Redesign

April 2017 ~

The Ohio Department of Medicaid (ODM) and Ohio Department of Mental Health and Addiction Services (OhioMHAS) has announced major policy and operational updates related to Behavioral Health Redesign.

The modifications include the following policy and operational updates related to Behavioral Health Redesign:

• QMHS+3 years may provide MH Day Treatment: ODM and OhioMHAS are committed to supporting the existing and available workforce to provide critical behavioral health services. As such, a Qualified Mental Health Specialist (QMHS) with a minimum of 3 years of experience (without a Bachelor’s or Master’s degree) in a relevant field as determined by the employing agency may render MH Day Treatment. This includes MH Day Treatment per hour up to two hours – (H2012 UK HQ) and MH Day Treatment per diem (H2020 UK). A QMHS+3 may provide MH Day Treatment at a rate of $15.76 per person, per hour and $88.87 per person, per day. All MH Day Treatment programs must be supervised by an independently licensed practitioner. The 3 years of experience are not restricted to a single agency, do not have to be contiguous, and must be documented in the agency employment record.
• Therapeutic Behavioral Service (TBS) and Psychosocial Rehabilitation (PSR): TBS/PSR services rendered in an office (POS 11) or a community mental health center (POS 53) for more than 90 minutes provided by the same agency, to the same recipient, on the same calendar day will be at 50% of the rate. TBS/PSR services provided in all other places of services will be paid at 100% of the rate after 90 minutes. This is a change to previous guidance which stated that Medicaid reimbursement for more than 90 minutes of TBS or PSR provided by the same agency, to the same recipient, on the same calendar day would be paid at 50% of the rate.
• Nursing Services: There will be no limits to medically necessary nursing services. There will no longer be a limit of 24 hours (96 units) for Mental Health or SUD Nursing services per patient, per calendar year. This is a change to previous guidance regarding Mental Health Nursing Services H2019 (RN) and H2017 (LPN) and SUD Nursing Services T1002 (RN) and T1003 (LPN).
• Medicaid Information Technology System (MITS) Trading Partner testing: The timeline for trading partner EDI file testing has been expanded from two weeks to six weeks. Trading partners will be able to start testing on May 1, 2017. ODM and OhioMHAS will be monitoring which providers have participated in testing to prepare for implementation, and providers who do so will receive a certificate of completion from the State.
• Rapid Response Team: ODM and OhioMHAS are committed to providing a smooth transition period as providers switch to the new code set in July, 2017. As part of this effort, ODM and OhioMHAS will establish a Rapid Response team that will be available beginning in July, 2017 to provide technical assistance 6 days a week for any issues related to claims payment or processing time.
• Monitoring Implementation: ODM and OhioMHAS are implementing a plan to monitor the Behavioral Health Redesign. We will monitor claims payment and processing times to ensure that a timely payment mechanism is in place when we transition to the new system in July.

For more information, refer to Ohio’s Behavioral Health Medicaid Redesign webpage.

Source(s): HMA; Ohio Department of Mental Health and Addiction Services;