907 KAR 15:025.
Reimbursement provisions and requirements regarding behavioral health services
provided by behavioral health services organizations.
RELATES TO: KRS 205.520, 42 U.S.C.
1396a(a)(10)(B), 42 U.S.C. 1396a(a)(23)
STATUTORY AUTHORITY: KRS 194A.030(2),
194A.050(1), 205.520(3)
NECESSITY, FUNCTION, AND CONFORMITY: The
Cabinet for Health and Family Services, Department for Medicaid Services, has a
responsibility to administer the Medicaid Program. KRS 205.520(3) authorizes
the cabinet, by administrative regulation, to comply with any requirement that
may be imposed or opportunity presented by federal law to qualify for federal
Medicaid funds. This administrative regulation establishes the reimbursement
provisions and requirements regarding Medicaid Program behavioral health
services provided by behavioral health services organizations to Medicaid
recipients who are not enrolled with a managed care organization.
Section 1. General Requirements. For the
department to reimburse for a service covered under this administrative
regulation, the service shall:
(1) Meet the requirements established in
907 KAR 15:020; and
(2) Be covered in accordance with 907 KAR
15:020.
Section 2. Reimbursement. (1) One (1)
unit of service shall be:
(a) Fifteen (15) minutes in length; or
(b) The unit amount identified in the corresponding:
1. Current procedural terminology code;
or
2. Healthcare common procedure coding
system code.
(2) The rate per unit for a screening or
for crisis intervention shall be:
(a) Seventy-five (75) percent of the rate
on the Kentucky-specific Medicare Physician Fee Schedule for the service if
provided by a:
1. Physician; or
2. Psychiatrist;
(b) 63.75 percent of the rate on the Kentucky-specific
Medicare Physician Fee Schedule for the service if provided by:
1. An advanced practice registered nurse;
or
2. A licensed psychologist;
(c) Sixty (60) percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided by
a:
1. Licensed professional clinical
counselor;
2. Licensed clinical social worker;
3. Licensed psychological practitioner;
4. Licensed marriage and family
therapist; or
5. Licensed professional art therapist;
or
(d) Fifty-two and five-tenths (52.5) percent
of the rate on the Kentucky-specific Medicare Physician Fee Schedule for the
service if provided by a:
1. Marriage and family therapy associate
working under the supervision of a billing supervisor;
2. Licensed professional counselor associate
working under the supervision of a billing supervisor;
3. Licensed psychological associate
working under the supervision of a billing supervisor;
4. Certified social worker working under
the supervision of a billing supervisor;
5. Physician assistant working under the
supervision of a billing supervisor;
6. Licensed professional art therapist associate
working under the supervision of a billing supervisor; or
7. Certified alcohol and drug counselor
working under the supervision of a billing supervisor.
(3) The rate per unit for an assessment
shall be:
(a) Seventy-five (75) percent of the rate
on the Kentucky-specific Medicare Physician Fee Schedule for the service if
provided by a:
1. Physician; or
2. Psychiatrist;
(b) 63.75 percent of the rate on the Kentucky-specific
Medicare Physician Fee Schedule for the service if provided by:
1. An advanced practice registered nurse;
or
2. A licensed psychologist;
(c) Sixty (60) percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided
by a:
1. Licensed professional clinical
counselor;
2. Licensed clinical social worker;
3. Licensed psychological practitioner;
4. Licensed marriage and family
therapist;
5. Licensed professional art therapist;
or
6. Licensed behavior analyst; or
(d) Fifty-two and five-tenths (52.5)
percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule
for the service if provided by a:
1. Marriage and family therapy associate
working under the supervision of a billing supervisor;
2. Licensed professional counselor associate
working under the supervision of a billing supervisor;
3. Licensed psychological associate
working under the supervision of a billing supervisor;
4. Certified social worker working under
the supervision of a billing supervisor;
5. Physician assistant working under the
supervision of a billing supervisor;
6. Licensed professional art therapist associate
working under the supervision of a billing supervisor;
7. Licensed assistant behavior analyst
working under the supervision of a billing supervisor; or
8. Certified alcohol and drug counselor
working under the supervision of a billing supervisor.
(4) The rate per unit for psychological
testing shall be:
(a) 63.75 percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided
by a licensed psychologist;
(b) Sixty (60) percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided
by a licensed psychological practitioner; or
(c) Fifty-two and five-tenths (52.5)
percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule
for the service if provided by a licensed psychological associate working under
the supervision of a licensed psychologist.
(5) The rate per unit for individual outpatient
therapy, group outpatient therapy, or collateral outpatient therapy shall be:
(a) Seventy-five (75) percent of the rate
on the Kentucky-specific Medicare Physician Fee Schedule for the service if
provided by a:
1. Physician; or
2. Psychiatrist;
(b) 63.75 percent of the rate on the Kentucky-specific
Medicare Physician Fee Schedule for the service if provided by:
1. An advanced practice registered nurse;
or
2. A licensed psychologist;
(c) Sixty (60) percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided
by a:
1. Licensed professional clinical
counselor;
2. Licensed clinical social worker;
3. Licensed psychological practitioner;
4. Licensed marriage and family
therapist;
5. Licensed professional art therapist;
or
6. Licensed behavior analyst; or
(d) Fifty-two and five-tenths (52.5)
percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule
for the service if provided by a:
1. Marriage and family therapy associate
working under the supervision of a billing supervisor;
2. Licensed professional counselor associate
working under the supervision of a billing supervisor;
3. Licensed psychological associate
working under the supervision of a billing supervisor;
4. Certified social worker working under
the supervision of a billing supervisor;
5. Physician assistant working under the
supervision of a billing supervisor;
6. Licensed professional art therapist associate
working under the supervision of a billing supervisor;
7. Licensed assistant behavior analyst
working under the supervision of a billing supervisor; or
8. Certified alcohol and drug counselor
working under the supervision of a billing supervisor.
(6) The rate per unit for family
outpatient therapy shall be:
(a) Seventy-five (75) percent of the rate
on the Kentucky-specific Medicare Physician Fee Schedule for the service if
provided by a:
1. Physician; or
2. Psychiatrist;
(b) 63.75 percent of the rate on the Kentucky-specific
Medicare Physician Fee Schedule for the service if provided by:
1. An advanced practice registered nurse;
or
2. A licensed psychologist;
(c) Sixty (60) percent of the rate on the
Kentucky-specific Medicare Physician Fee Schedule for the service if provided
by a:
1. Licensed professional clinical
counselor;
2. Licensed clinical social worker;
3. Licensed psychological practitioner;
4. Licensed marriage and family
therapist; or
5. Licensed professional art therapist;
or
(d) Fifty-two and five-tenths (52.5)
percent of the rate on the Kentucky-specific Medicare Physician Fee Schedule
for the service if provided by a:
1. Marriage and family therapy associate
working under the supervision of a billing supervisor;
2. Licensed professional counselor associate
working under the supervision of a billing supervisor;
3. Licensed psychological associate
working under the supervision of a billing supervisor;
4. Certified social worker working under
the supervision of a billing supervisor;
5. Physician assistant working under the
supervision of a billing supervisor;
6. Licensed professional art therapist associate
working under the supervision of a billing supervisor; or
7. Certified alcohol and drug counselor
working under the supervision of a billing supervisor.
(7) Reimbursement for the following
services shall be as established on the BHSO Non-Medicare Services Fee
Schedule:
(a) Mobile crisis services;
(b) Day treatment;
(c) Peer support services;
(d) Parent or family peer support
services;
(e) Intensive outpatient program
services;
(f) Service planning;
(g) Residential services for substance
use disorders;
(h) Screening, brief intervention, and
referral to treatment;
(i) Assertive community treatment;
(j) Comprehensive community support
services; or
(k) Therapeutic rehabilitation services.
(8)(a) The department shall use the
current version of the Kentucky-specific Medicare Physician Fee Schedule for reimbursement
purposes.
(b) For example, if the Kentucky-specific
Medicare Physician Fee Schedule currently published and used by the Centers for
Medicare and Medicaid Services for the Medicare Program is:
1. An interim version, the department
shall use the interim version until the final version has been published; or
2. A final version, the department shall
use the final version.
(9) The department shall not reimburse
for a service billed by or on behalf of an entity or individual that is not a
billing provider.
Section 3. No Duplication of Service. (1)
The department shall not reimburse for a service provided to a recipient by
more than one (1) provider of any program in which the service is covered
during the same time period.
(2) For example, if a recipient is
receiving a behavioral health service from an independent behavioral health
provider, the department shall not reimburse for the same service provided to
the same recipient during the same time period by a behavioral health services
organization.
Section 4. Not Applicable to Managed Care
Organizations. A managed care organization shall not be required to reimburse in
accordance with this administrative regulation for a service covered pursuant
to:
(1) 907 KAR 15:020; and
(2) This administrative regulation.
Section 5. Federal Approval and Federal
Financial Participation. The
department’s reimbursement for services pursuant to this administrative
regulation shall be contingent upon:
(1) Receipt of federal financial
participation for the reimbursement; and
(2) Centers for Medicare and Medicaid
Services’ approval for the reimbursement.
Section 6. Incorporation by Reference.
(1) "BHSO Non-Medicare Services Fee Schedule", July 2014, is
incorporated by reference.
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at:
(a) The Department for Medicaid Services,
275 East Main Street, Frankfort, Kentucky, Monday through Friday, 8:00 a.m. to
4:30 p.m.; or
(b) Online at the department’s Web site
at http://www.chfs.ky.gov/dms/incorporated.htm.
(41 Ky.R. 700; Am. 1398; 1656; eff. 2-6-2015.)
