Keeping Kids First. List of Approved Units of Service

Transcription

1 St. Louis County Children s Service Fund Keeping Kids First List of Approved Units of Service January 1, 2015 i

2 Table of Contents Service Rate Determination and Definition v Case Management - (Forensic Masters) 1 Case Management - (Forensic PhD) 2 Case Management - (Masters) 3 Case Management - (Bachelors) 4 Case Mgt - (Adm Support Services) 5 Case Mgt -School-Based Coordination 6 Counseling (Home) 7 Counseling (Home) 8 Counseling (Home) 9 Counseling (Office) 10 Counseling (Office) 11 Counseling (Office) 12 Counseling (Psychoeducational Group) 13 Counseling (Therapeutic Group) 14 Crisis Intervention 15 Day Treatment 16 Community Support Services 17 Drop-in Services 18 Drug Test: 25H; 25H-NBOMe; 25I; 25I-NBOMe; 2C-C; 2C-C-NBOMe 19 Drug Test: 5 or 10 Panel 20 Drug Test: Mushrooms; psilocine; psilocyn; psilotsin; psychedelic mushrooms 21 Drug Test: Synthetic Cannabinoids 22 Familial Investigation 23 Family Stabilization Services 24 Forensic Interview 25 ii

3 Health Professional Home Visit 26 Intensive Outpatient Program (IOP) 27 Intensive Shelter Services 28 Interpretation/Translation 29 Materials and Supplies 30 Fiscal Agent Fee 31 Multisystemic Therapy (EBP-MST) 32 Naltrexone 33 Non-Therapeutic Counseling (Home) 34 Non-Therapeutic Counseling (Home) 35 Non-Therapeutic Counseling (Home) 36 Non-Therapeutic Counseling (Office) 37 Non-Therapeutic Counseling (Office) 38 Non-Therapeutic Counseling (Office) 39 Outpatient Substance Abuse Treatment Medication Administration 40 Presentation (Street Outreach) 41 Presentation (Multiple Presenters) 42 Presentation (Single Presenter) 43 Psychiatry 44 Psychiatric Diagnostic Evaluation 45 Psychological Testing by Technician 46 Respite Day (Acute) 47 Respite Day (Administrative Support Services) 48 Respite Day (Non Acute) 49 Respite for Medically Fragile Children 50 Respite for Medically Fragile Children 51 Respite Hour (Acute) 52 iii

4 Respite Hour (Non Acute) 53 Shelter Services Temporary Shelter 54 Shelter Services Transitional Living 55 Shelter Administrative Support Services 56 Shelter Services-Child/Dependent 57 Street Outreach 58 Suboxone 59 Substance Abuse Counseling Psycho-educational Group 60 Substance Abuse Individual Counseling 2 61 Substance Abuse Individual Counseling 2 62 Substance Abuse Individual Counseling 3 65 Substance Abuse Individual Counseling 3 66 Therapeutic Mentoring 67 Trauma Focused Counseling 68 Trauma Focused Counseling 69 Vivitrol 70 iv

5 Service Rate Determination and Definition The service rate determination model is based on the standard clinical activities performed on the child s behalf. These activities are associated standards of effort and rates as published by the AMA or other third party sources which are factual and evidential. Once established the standard activities defined under Current Procedural Terminology (CPT) or industry practice, become the basis of the contract with agencies (Schedule B) and the associated value of effort which will remain constant across demographics, location and year. CPT Code: The Current Procedural Terminology (CPT) code published by the American Medical Association (AMA), or other third party sources, is the basis for the medical and behavioral health procedures, activities and relative values of effort. The Children s Service Fund recognizes provider s innovation and unique approach to service delivery. Providers are encouraged to request additional units of service when a project requires different activities and values of effort. CPT codes and related activities when appropriate are grouped by class. For example, 30, 45, and 60 minute counseling sessions are three separate CPT codes within the same class. Providers can invoice for any of the items in the class as long as one of the class items is listed in the contract. The standard unit of measure or time for which the value of effort is based. Time standards represent a stated range. For example: 45 minutes is equal to between 38 and 52 minutes. The minimum level of education or licensure necessary to be reimbursed for the service. The standard definition of activities included for this service. Standard activities as defined by the CPT code become the basis for standard units of efforts and the contractual commitment of service delivered. Documentation Required: The method by which the clinical activities required are documented and available for periodic audit. For most services the Children s Service Fund will follow Missouri standard progress notes requirements as defined under Missouri CSR Relative value units (): The resources used to provide each service. For example, a physician s resources would be the work performed (direct care), the expenses of his practice expenses (PE) or also known as administration expense and the professional liability insurance or malpractice insurance (). s take into account the time involved, minimum qualifications of the staff and any specialized equipment or procedures used. Conversion Factor per AMA: This is the Consumer Price Index which is the most widely used measure of inflation and is adjusted annually. : Represents the Children s Service Fund Board s adjustment to the rate to allow for focused capacity building and emphasis on specific service areas. Component Rate: The dollar amount by direct, administration, and malpractice costs arrived at by multiplying the respective times the Conversion Factor per the AMA and. : Final contractual rate. v

6 Case Management - (Forensic Masters) CSF CPT Code: T minutes Master's degree in human services field or criminal justice Services provided include recommendations to courts, law enforcement, or child protective services, either written, telephonic, or in person, regarding the custody, placement and child welfare of at-risk children. (Minimum of 5 minutes). Administrative Overhead (Non Billable) - administrative activities are included in the formula for the case management unit cost and can t be billed separately. Examples include: Staff Supervision; Training; meetings; Linking clients to resources outside of service plan ( i.e. accessing food pantry); Making copies; Notifying clients of scheduling changes; Creating lists of resources for clients; Assisting with initial paperwork; Scheduling appointments ( i.e. calling to arrange a date of service for a client); Coordinating client transportation needs; Intake process; Marketing of services; Filing. Relative Value Unit Work Factor Per 15 minutes $

7 Case Management - (Forensic PhD) CSF CPT Code: T minutes MD/PhD in Psychology and Psychiatry Services provided include recommendations to courts, law enforcement, or child protective services, either written, telephonic, or in person, regarding the custody, placement and child welfare of at-risk children. (Minimum of 5 minutes). Administrative Overhead (Non Billable) - administrative activities are included in the formula for the case management unit cost and can t be billed separately. Examples include: Staff Supervision; Training; meetings; Linking clients to resources outside of service plan ( i.e. accessing food pantry); Making copies; Notifying clients of scheduling changes; Creating lists of resources for clients; Assisting with initial paperwork; Scheduling appointments ( i.e. calling to arrange a date of service for a client); Coordinating client transportation needs; Intake process; Marketing of services; Filing. Relative Value Unit Work Factor Per 15 minutes $

8 Case Management - (Masters) CSF CPT Code: T minutes Master's degree in human services field and/or Advanced Practice Registered Nurse (APRN) Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Services include: Engage and Communicate with youth and their families; Coordinate and Communicate with youth and their families; Coordinate and Communicate with service providers; Refer and Link to services provided by external behavioral programs; Research and Advocate on behalf of client; Assist youth to apply for needed benefits; Assist youth to obtain personal identification; Coordinat weekend home visits; Coordinat needed appointments; Phone calls with or on behalf of client; Attend court hearings; and attend meetings on behalf of client; and mandated hotline reports. Services can take place in the home, office, school, or other community site. Case management services can be performed on behalf of a school population when required by school administration in order to provide services in a school setting. (Minimum of 5 minutes). Administrative Overhead (Non Billable) - administrative activities are included in the formula for the case management unit cost and can t be billed separately. Examples include: Staff Supervision; Training; meetings; Linking clients to resources outside of service plan ( i.e. accessing food pantry); Making copies; Notifying clients of scheduling changes; Creating lists of resources for clients; Assisting with initial paperwork; Scheduling appointments ( i.e. calling to arrange a date of service for a client); Coordinating client transportation needs; Intake process; Marketing of services; Filing. Relative Value Unit Work Factor Per 15 minutes $

9 Case Management - (Bachelors) CSF CPT Code: T minutes Bachelor's degree in human services field or equivalent Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the client's human service needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost-effective interventions and outcomes. Services include: Engage and Communicate with youth and their families; Coordinate and Communicate with youth and their families; Coordinate and Communicate with service providers; Refer and Link to services provided by external behavioral programs; Research and Advocate on behalf of client; Assist youth to apply for needed benefits; Assist youth to obtain personal identification; Coordinat weekend home visits; Coordinat needed appointments; Phone calls with or on behalf of client; Attend court hearings; and attend meetings on behalf of client; and mandated hotline reports. Services can take place in the home, office, school, or other community site. Case management services can be performed on behalf of a school population when required by school administration in order to provide services in a school setting. (Minimum of 5 minutes). Administrative Overhead (Non Billable) - administrative activities are included in the formula for the case management unit cost and can t be billed separately. Examples include: Staff Supervision; Training; meetings; Linking clients to resources outside of service plan ( i.e. accessing food pantry); Making copies; Notifying clients of scheduling changes; Creating lists of resources for clients; Assisting with initial paperwork; Scheduling appointments ( i.e. calling to arrange a date of service for a client); Coordinating client transportation needs; Intake process; Marketing of services; Filing. Relative Value Unit Work Factor Per 15 minutes $

10 Case Mgt - (Adm Support Services) CSF CPT Code: T minutes Bachelor's degree in human services field or equivalent Administrative case management when an organization trains volunteer case managers to provide services to youth 19 and younger. Services provided by volunteer case managers are performed free of charge and incur no cost to an organization other than training expenses. (Minimum of 5 minutes). Administrative Overhead (Non Billable) - administrative activities are included in the formula for the case management unit cost and can t be billed separately. Examples include: Staff Supervision; Training; meetings; Linking clients to resources outside of service plan ( i.e. accessing food pantry); Making copies; Notifying clients of scheduling changes; Creating lists of resources for clients; Assisting with initial paperwork; Scheduling appointments ( i.e. calling to arrange a date of service for a client); Coordinating client transportation needs; Intake process; Marketing of services; Filing. Relative Value Unit Work Factor Per 15 minutes $

11 Case Mgt -School-Based Coordination CSF CPT Code: T minutes T , 2014 CSF School Based Provider Listening Sessions Bachelor s Degree in human service field School- based coordination is for use by mental health professionals providing service on school grounds or prevention staff in managing implementation of services to students. This unit is to be billed for the expressed purpose advancing service delivery in school environment for the benefit of student populations. Each billed activity must be documented independently in the case notes associated with the school or client. Activities include: participating in school district/school led meetings, coordinating schedules for services to be conducted with individual students or groups of students; consultation on behavioral health issues for the general school population; and student observations not associated with an established service plan. Staff supervision, meetings convened by CSF, meetings in which client, school staff or other colaborating agency are not present, Desinated client as the school, classroom or teacher Relative Value Unit Work Factor Per 15 minutes $

12 Counseling (Home) CSF CPT Code: (16-37) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment performed in a client's residence, school, or other community-based setting, for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult), family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library), staff must visit five or more sites in a workday. (To be billed as a whole unit). Relative Value Unit Work Factor Per 30 (16-37) minutes $

13 Counseling (Home) CSF CPT Code: (38-52) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment performed in a client's residence, school, or other community-based setting, for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult), family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library), staff must visit five or more sites in a workday. (To be billed as a whole unit). Relative Value Unit Work Factor Per 45 (38-52) minutes $

14 Counseling (Home) CSF CPT Code: (53-67) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment performed in a client's residence, school, or other community-based setting, for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult), family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library), staff must visit five or more sites in a workday. (To be billed as a minimun of 1 unit and a portion of a unit in excess of 1 unit. Example: 1.25 = 1 hour 15 minutes). Relative Value Unit Work Factor Per 60 (53-67) minutes $

15 Counseling (Office) CSF CPT Code: (16-37) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult) and family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a whole unit). Relative Value Unit Work Factor Per 30 (16-37) minutes $

16 Counseling (Office) CSF CPT Code: (38-52) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult) and family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a whole unit). Relative Value Unit Work Factor Per 45 (38-52) minutes $

17 Counseling (Office) CSF CPT Code: (53-67) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Treatment for mental illness and behavioral disturbances in which the clinician establishes a professional contact with the patient and, through definitive therapeutic communication, attempts to alleviate the emotional disturbances, reverse or change maladaptive patterns of behavior, and encourage personal growth and development. This service includes individual (child or adult) and family counseling, and counseling or coaching services for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of preventing child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a minimum of 1 unit and a portion of a unit in excess of 1 unit. Example: 1.25 = 1 hour 15 minutes). Relative Value Unit Work Factor Per 60 (53-67) minutes $

18 CSF CPT Code: Counseling (Psychoeducational Group) T (53-67) minutes Bachelor's degree in human services field or equivalent Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (3-12 people unless otherwise dictated by intervention specific modality) (separate procedure). Sessions can be designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, maladaptive patterns of behavior or to prevent relapse. Activities can be designed to develop youth s decisionmaking, problem-solving and healthy interpersonal skills by exposing youth to educational and enriching life experiences. This unit should be used to bolster service plans that are designed to increase independent living skills in complimentary programs (i.e. substance abuse treatment, transitional living services). These sessions can occur in community-based settings. (Can bill a portion of an hour portion with a minimum of 15 minutes. Billed per child per hour. Example: 3 children for 45 min. = 3 X.75 = 2.25 units). Roster, Program curriculum, pre/post test or survey unless otherwise specified by the evidence based practice or modality Progress Note by client per MO-CSR (per Group Focus committee) Relative Value Unit Work Factor Per 60 (53-67) minutes $

19 Counseling (Therapeutic Group) CSF CPT Code: (53-67) minutes Master's degree in human services field and licensed/provisionally licensed in MO and/or Advanced Practice Registered Nurse (APRN) Group psychotherapy session, exploring mental and emotional interactions between patients (3-12 people unless otherwise dictated by intervention specific modality), utilizing techniques to modify inappropriate behavior and heal emotionally. Group sessions are not limited to patients with similar disorders. (Can bill a portion of an hour with a minimum of 15 minutes). Progress Note Per Child per MO-CSR Relative Value Unit Work Factor Per 60 (53-67) minutes $

20 CSF CPT Code: Crisis Intervention H minutes Master's degree in human services field and/or Advanced Practice Registered Nurse (APRN) Community-based crisis intervention services are immediate, crisis-oriented case management services designed to ameliorate or minimize an acute crisis episode and/or to prevent inpatient psychiatric hospitalization or medical detoxification. Services are provided to adults, adolescents, and their families or support systems who have suffered a breakdown of their normal strategies or resources and who exhibit acute problems or disturbed thoughts, behaviors, or moods. These services are characterized by the need for highly coordinated services across a range of service systems. Crisis intervention services should be available on a 24 hour, 7-day a week basis. Services can be provided by a mobile team or by a crisis program in a facility or clinic. Crisis intervention services include: advocacy, crisis hotline services, crisis prevention, information and referral, primary assessment, secondary evaluation, acute crisis services and support services. (Minimum of 5 minutes). Relative Value Unit Work Factor Per 15 minutes $

21 CSF CPT Code: Day Treatment H0035 Day Bachelor s Degree in human service field with certification and license in field of study. A highly intense, planned, structured, multidisciplinary, multi-modal structured treatment, provided 4-8 hours per day, 3-7 days per week. Day treatment mirrors the nature and intensity of inpatient except the client is not in 24 hour care. The program is designed to restore and maintain the functioning of individuals with serious substance abuse and/or co-occurring disorders. Services provided may include: Assessment (multi-axil), Individual counseling, Medical and nursing support, Medication management, Relapse Prevention Counseling, Case Management, Group Education, Group Therapy, Consultation and/or referral for general medical, psychiatric, and psychopharmacology needs, Family conference, Family counseling, Educational support, Vocational support, Recreational therapy, Life Skills development, Refusal Skills training, and meals. The purpose of the day treatment is to provided intensive treatment to sustain client in their home and community environment, and to stabilized emotional and mental health functioning and reduce psychiatric hospitalizations. Day Treatment services are provided to clients who are not being successful in home, school and community and require a more intensive therapeutic environment. (1/2 Day minimum or 0.5 of a unit). Relative Value Unit Work Factor Per Day $

22 CSF CPT Code: Community Support Services H minutes ; 2013 RBVS; 2014 RBRVS; MSAPCB High School diploma or equivalent and trained in service delivery as prescribed by the agency s service model; for Substance Abuse treatment purposes: High school diploma/equivalent or Associate s degree as well as Recognized Associate Substance Abuse Counselor (RASAC I or II certification) per requirements as set forth by the Missouri Substance Abuse Professional Credentialing Board. Providing a client/patient with face-to-face support to ensure that the client/patient is informed regarding his or her treatment and/or service plan. Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a whole unit). Relative Value Unit Work Factor Per 15 minutes $

23 CSF CPT Code: Drop-in Services H0023 Hour High school diploma or equivalent Drop-in centers are fixed-site programs, easily accessible to homeless youth and youth seeking resources. Drop-in centers provide: a safe place, with comfortable seating; food or snacks; telephone access; clothing; and bathroom facilities with showers. Additionally provided directly or by referral: crisis intervention; information and referral; and access to treatment and/ or medical services. This unit cannot be billed in tandem with other units. (Can bill a portion of an hour with a 15 minute minimum). Roster of youth utilizing drop-in services, including: signature; age; date, time in and out; and documentation of initial services sought. Relative Value Unit Work Factor Per Hour $

24 Drug Test: 25H; 25H-NBOMe; 25I; 25I- NBOMe; 2C-C; 2C-C-NBOMe CSF CPT Code: Each Medtox.com recommended CPT codes for each test. Certified vendor Drug screen, qualitative; single drug class method (e.g., immunoassay, enzyme assay), each drug class. Relative Value Unit Work Factor Per Each $

25 Drug Test: 5 or 10 Panel CSF CPT Code: Each Medtox.com recommended CPT codes for each test. Certified vendor Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure. Relative Value Unit Work Factor Per Each $

26 CSF CPT Code: Drug Test: Mushrooms; psilocine; psilocyn; psilotsin; psychedelic mushrooms Each Medtox.com recommended CPT codes for each test. Certified vendor Column chromatography/mass spectrometry (e.g., GC/MS, or HPLC/MS), analyze not elsewhere specified; qualitative, single stationary and mobile phase. Relative Value Unit Work Factor Per Each $

27 Drug Test: Synthetic Cannabinoids CSF CPT Code: Each Medtox.com recommended CPT codes for each test. Certified vendor Column chromatography/mass spectrometry (e.g., GC/MS, or HPLC/MS), analyze not elsewhere specified; quantitative, single stationary and mobile phase. Relative Value Unit Work Factor Per Each $

28 Familial Investigation CSF CPT Code: H minutes Bachelor's degree in human services field or equivalent Familial investigation with the purpose to identify relatives/kin of children in foster care including: internet searches, data mining, phone calls, and face-to-face meetings to gather names, contact information, birth/death dates, educational/work history, criminal background information, etc. Sources of information include: court records, Children s Division records, vital records, obituaries, social media, real estate/property tax information, etc. Family assessment is conducted to determine if a relative/kin may be an appropriate placement for the child. The Missouri Children s Division Home Safety Checklist (CS-45) is completed and background checks are submitted. Barriers to relatives meeting the CS-45 are addressed. (Bill in portion of a unit with a minimum of 5 minutes). Relative Value Unit Work Factor Per 15 minutes $

29 Family Stabilization Services CSF CPT Code: S minutes Master s degree in human services field or equivalent and/or Advanced Practice Registered Nurse (APRN) Family Stabilization activities are time-limited intensive therapeutic and supportive interventions delivered in the home or in another location that is a natural setting for family interaction. These service are designed for children or youth at risk of or diagnosed with SED, NBD, or behavioral disorders, and their families who: require multiple home/community-based services or resources in order to adequately address treatment needs; or are transitioning from institutional or highly restrictive settings to community-based setting; or are at risk of out-of-home placement. These services are designed to strengthen and preserve families by providing needs driven, comprehensive, integrated approaches to services. Services are multi-faceted in nature and include: situation management, environmental assessment, interventions to improve individual and family interactions, skill training, self and family management, and coordination and linkage with other services and supports. The need for Family Stabilization services must be documented in the individual s assessment and treatment plan. Documented crisis response plan, which is reviewed, and updated on a regular basis. The majority (60% or more) of services provided by agency staff must be face-to-face and in vivo (where the client is). The agency must have the capacity to provide crisis response services 24/7. (Bill in portion of a unit with a minimum of 5 minutes). Relative Value Unit Work Factor Per 15 minutes $

30 Forensic Interview CSF CPT Code: Hour Master's degree in human services field The collection and documentation of narrative evidence, from a victim and their caregivers, following an alleged incident of sexual abuse, severe physical abuse, and/or witness to a violent crime. (Bill in portion of a unit with a minimum of 15 minutes) Relative Value Unit Work Factor Per Hour $

31 Health Professional Home Visit CSF CPT Code: (53-67) minutes Bachelor s degree in nursing and registered in Missouri or Missouri certification and possession of a current license to practice as a Registered Nurse Visit provided by a home health professional to evaluate specific needs of a client. If home behavioral health care would be of benefit, a plan of care is developed. A plan may specify one or more visits from a therapist. The provider regularly reviews progress reports. (Bill in portion of a unit with a minimum of 15 minutes). Relative Value Unit Work Factor Per 60 (53-67) minutes $

32 CSF CPT Code: Intensive Outpatient Program (IOP) H0015 Hour Master s Degree and Bachelor s Degree in human service field with certification and license in field of study. Intensive Outpatient Planned, structured multidisciplinary, multi-modal structured treatment, provided in segments of at least 2 hours per day, 3 5 times per week with groups of no fewer than three and no more than 12 clients. Services provided include 3 or more of the following: Assessment, Individual counseling, Relapse Prevention Counseling, Case Management, Group Education, Group Therapy, Consultation and/or referral for general medical, psychiatric, and psychopharmacology needs, Family conference, Family counseling, Educational support, Vocational support, Life Skills development, Refusal Skills training. (1 Hour minimum). Relative Value Unit Work Factor Per Hour $

33 Intensive Shelter Services CSF CPT Code: H Day High school diploma or equivalent Food, clothing, and temporary shelter services for abused, neglected, run away, homeless, or emotionally disturbed youth. Shelter services meet the basic needs of individuals and families who are homeless or in transition, set them on the path toward stable family or independent living, and provide a point-of-entry to the continuum of community care. Required staffing ratio at or better than Day 1:4 & night 1:6. (1/2 Day minimum). Relative Value Unit Work Factor Per Day $

34 CSF CPT Code: Interpretation/Translation T minutes High school diploma or equivalent Providing a client/patient with face-to-face, foreign language interpretation/translation, to ensure that the client/patient is informed regarding his or her treatment and/or treatment plan. (Bill in portion of a unit with a minimum of 5 minutes). Relative Value Unit Work Factor Per 15 minutes $

35 Materials and Supplies CSF CPT Code: Each N/A In association with an approved training curriculum Educational supplies and materials (e.g. published course book) required for an evidenced-based training curriculum as a defined element of the program. Materials and supplies are to be billed on a per person or per session basis. Must be billed in association with an approved training curriculum. Reimbursed at actual cost rounded to $1.00. Normal and customary supplies Roster of attendees receiving materials. Documentation supporting actual and reasonable approved costs. Relative Value Unit Work Factor Per Each $

36 Fiscal Agent Fee CSF CPT Code: Each IRS, Grant makers for Effective Organizations Well-established nonprofits who are current CSF partners approved by CSF and have acceptable financial standing and experience. The fiscal agent fee is established to reimburse an existing agency for administrative and support services provided to a separate organization (Supported Agency) which is not currently funded and which lacks the clinical, infrastructural, organizational, financial stability or internal controls necessary to be approved for funding by the. Fiscal agents do not have control over the contracted project. The supported agency delivers the direct services and has no obligation to provide service information to the fiscal agent or allow involvement beyond acceptance of the CSF investment and management of the invoice process. Fiscal agents accept and manage funds and provide the required record-keeping. Fiscal agents charge usual and customary administrative fees for the service and have an executed formal agreement between then fiscal agent and supported agency detailing services, deliverables and rates. Fiscal agents must maintain receipts and record-keeping for all funds received and expenditures associated with supporting the supported agency. The fiscal agent must also uphold CSF standards and rules regarding disbursement. The fiscal agent ensures that funds are disbursed to the client as requested by CSF. Fiscal agent fee will be set by the and invoiced to CSF as a dollar amount calculated as a percentage of the billed amount by the supported agency. Supervision, meetings and audits. Contract between Fiscal agency and the supported agency detailing services, deliverables and rates, invoices, and proof of service (client, dates, times, professional). 31

37 CSF CPT Code: Multisystemic Therapy (EBP-MST) H minutes Master's degree in human services field and licensed/provisionally licensed in MO. Organizations providing MST are licensed by MST Services, Inc or any of its approved subsidiaries. Multisystemic Therapy (MST) provides time-limited (average of 5 months), intensive family and communitybased treatment for youth between the ages 12 through 17 who are at risk of out-of-home placement or who are returning home from placement, and their families. MST uses evidence-based interventions to target specific behaviors related to serious antisocial and delinquent behavior across multiple settings, or systems, including the family, peers, school, and neighborhood. MST therapists, as a member of a larger team, are available to families 24 hours a day and provide direct therapeutic interventions and also arrange, coordinate, and monitor services on behalf of the youth and family. Services are provided in the home, community, by telephone. (Bill in portion of a unit with a minimum of 5 minutes). Relative Value Unit Work Factor Per 15 minutes $

38 Naltrexone CSF CPT Code: J Each RN/NP/MD Psychotropic medications for substance abuse symptoms (Vivitrol, suboxone, naltrexone); does not include injection or administration by a medical professional. Priced per one month course. Can be billed on portion of a monthly course. Relative Value Unit Work Factor Per Each $

39 Non-Therapeutic Counseling (Home) CSF CPT Code: (16-37) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library) must visit five or more sites in a workday. (To be billed as a whole unit). Relative Value Unit Work Factor Per 30 (16-37) minutes $

40 Non-Therapeutic Counseling (Home) CSF CPT Code: (38-52) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library) must visit five or more sites in a workday. (To be billed as a whole unit). Relative Value Unit Work Factor Per 45 (38-52) minutes $

41 Non-Therapeutic Counseling (Home) CSF CPT Code: (53-67) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. For community-based sites (e.g. schools, library) must visit five or more sites in a workday. (Minimum of 1 unit and a portion of a unit in excess of 1 unit. Example: 1 hour 15 minutes = 1.25). Relative Value Unit Work Factor Per 60 (53-67) minutes $

42 Non-Therapeutic Counseling (Office) CSF CPT Code: (16-37) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a whole unit). Relative Value Unit Work Factor Per 30 (16-37) minutes $

43 Non-Therapeutic Counseling (Office) CSF CPT Code: (38-52) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. (To be billed as a whole unit). Relative Value Unit Work Factor Per 45 (38-52) minutes $

44 Non-Therapeutic Counseling (Office) CSF CPT Code: (53-67) minutes Bachelor's degree in human services field or equivalent Counseling or coaching sessions for children and/or parents without a mental illness or behavioral disturbance for the purpose of adding or reinforcing protective factors. This includes one-on-one coaching sessions designed to educate or reinforce lessons learned for the purpose of reducing risk factors associated with child abuse, neglect, or maladaptive patterns of behavior. (Minimum of 1 unit and a portion of a unit in excess of 1 unit. Example: 1 hour 15 minutes = 1.25). Relative Value Unit Work Factor Per 60 (53-67) minutes $

45 Outpatient Substance Abuse Treatment Medication Administration CSF CPT Code: Each RN/NP/MD Administration of intramuscular and/or subcutaneous medication by health care agency/professional, per visit. This service is only for the administration of medication to an individual as ordered by the medical practitioner, excluding methadone and buprenorphine. Relative Value Unit Work Factor Per Each $

46 Presentation (Street Outreach) CSF CPT Code: H minutes High school diploma or equivalent Homelessness prevention information dissemination service, one-way direct or non-direct contact to affect knowledge and attitude to homeless youth or youth at risk for becoming homeless. Presentations can occur in a variety of settings within the community including schools, juvenile detention centers, and community based resource fairs. (Bill in portion of a unit with a minimum of 5 minutes of presentation, regardless of the number of attendees or the number of presenters). Attendance roster, verification of number of youth engaged, summary of presentation / curriculum, Pre/Post Test or Survey (one-time presentation) unless otherwise specified by evidence-based practice. Relative Value Unit Work Factor Per 15 minutes $

47 Presentation (Multiple Presenters) CSF CPT Code: H Hour Bachelor's degree in human services field or equivalent Behavioral health prevention information dissemination service, one-way direct or non-direct contact with service audiences (13+ people) to affect knowledge and attitude. Per Hour of presentation, greater than one presenter, regardless of attendees. (Bill in portion of a unit with a minimum of 15 minutes of presentation, regardless of the number of attendees or the number of presenters). Attendance roster, curriculum, Pre/Post Test or Survey (one-time presentation) unless otherwise specified by evidence-based practice. Relative Value Unit Work Factor Per Hour $

48 Presentation (Single Presenter) CSF CPT Code: H Hour Bachelor's degree in human services field or equivalent Behavioral health prevention information dissemination service, one-way direct or non-direct contact with service audiences (13+ people) to affect knowledge and attitude. Per Hour of presentation, single presenter, regardless of attendees. Can be billed as a portion of a unit. (Bill in portion of a unit with a minimum of 15 minutes of presentation, regardless of the number of attendees or the number of presenters). Attendance roster, curriculum, Pre/Post Test or Survey (one-time presentation) unless otherwise specified by evidence-based practice. Relative Value Unit Work Factor Per Hour

49 Psychiatry CSF CPT Code: 99214, 90833, (16-37) minutes MD or DO in psychiatry, board certified and licensed in MO Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Medication in conjunction with intensive outpatient services may be required to reduce or eliminate symptoms. (Billed in portion of a unit with 15 minute minimum or 0.5 of a unit). Relative Value Unit Work Factor Per 30 (16-37) minutes $

50 Psychiatric Diagnostic Evaluation CSF CPT Code: (53-67) minutes Doctorate degree in psychology and licensed/provisionally licensed in MO Psychiatric Dignostic Evaluation includes integrated biopsychosocial assessment including history, mental status and related recommendations with interpretation and report on presentation of findings, per hour. Completed as part of a psychiatric evaluation. (Can bill a portion of an hour with a 15 minute minimum). and Final Report Relative Value Unit Work Factor Per 60 (53-67) minutes $

51 Psychological Testing by Technician CSF CPT Code: (53-67) minutes Master s Degree in Clinical or School Psychology Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g. MA and WAIS), with qualified health care professional interpretation and report, administered by technician, per hour of technician time. (Can bill a portion of an hour with a 15 minute minimum). Progress Note and Final Report Relative Value Unit Work Factor Per 60 (53-67) minutes $

52 Respite Day (Acute) CSF CPT Code: T Day High school diploma or equivalent Respite care services are a program of care, in a supervised setting, for individuals with or at risk of serious emotional, behavioral, or neurobiological disorders (SED/NBD) or severe mental illness and/or serious addictive disorders. Children supported through this project will often display significant challenges with communication (may be nonverbal and/or use sign language or other augmentative communication system) and behavior (may display self-injurious behavior, aggression, property destruction, elopement and/or tantrums). The purpose of respite is to sustain the family or other primary caregiver by providing those individuals with time-limited temporary relief from the ongoing responsibility of care, with the goal of reducing family stress and keeping the family intact. Respite may be provided on either a planned or an emergency basis and may be provided in a variety of settings and in an individual or group environment. Ratio of staff is dependent upon the child's specific behaviors and safety needs and could range from two staff to one client (2:1) to one staff to three clients (1:3). (Bill in portion of a unit with a 1/2 day minimum or 0.5 of a unit). Relative Value Unit Work Factor Per Day $