907 KAR 15:025. Reimbursement provisions and requirements regarding behavioral health services provided by behavioral health services organizations

Link to law: http://www.lrc.ky.gov/kar/907/015/025.htm
Published: 2015

Subscribe to a Global-Regulation Premium Membership Today!

Key Benefits:

Subscribe Now
      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.)