Detailed Coding Grid (Medicaid and AAPS Funding): Updated 1/17/12

Transcription

1 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Case Management H0006 Case Management via H0006 GT to High School diploma 2 years SA work experience in a substance abuse treatment program Sign off by a LAC or LCAC counselor Approved provider KCPC, case management plan, Progress notes, end dates and times for the s 6/18/08, 11:00 am to 11:15 am would in or intensive modalities but must be face to face with the on behalf of the. Any. $12.50 per s = 1 unit per 16 units Linking individuals to s needed to assist in recovery. For example, Housing, Financial, Vocational, Educational, Mental health, and Physical health. Direct s such as: Child care, Teaching (GED coaching, computer skills) Job Skills, training Chores, Transportation, Parties, Movies, Dinner, AA/NA, Meal planning, and Life skills group.

2 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Person Centered Case Management (PCCM) H0006 HV PCCM via H0006 HV GT Block Grant Block Grant to BA/BS degree One year of experience in a substance abuse field may be used to substitute one year of education PCCM training Approved PCCM provider KCPC, Progress notes, based on a wellness plan and strengths based assessment, end dates and times for the s 6/18/08, 11:00 am to 11:15 am would in or intensive modalities or as a stand-alone but must be face to face with the on behalf of the. Block Grant priority populations - Plus- Adolescents Homeless $13.25 per s = 1 unit per 16 units Linking individuals to s needed to assist in recovery. For example, Housing, Financial, Vocational, Educational, Mental health, and Physical health. Direct s such as: Child care, Teaching (GED coaching, computer skills) Job Skills, training Chores, Transportation, Parties, Movies, Dinner, AA/NA, Meal planning, and Life skills group.

3 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Support s A0160 Block Grant Block Grant to High School diploma or equivalent Approved Block Grant provider end dates and times for the s 6/18/08,11:00 am to 12:00 pm would Transportation logs for all modalities but must occur outside of the agency. Must be face to face with the present. for any Block Grant $7.50 per s = 1 unit per 32 units Occurs outside of the agency. For example, transportation to and from Court Appointments Pharmacy Emergencies (such as medical or mental health) to transport members to the appropriate facility for their level of care for access to care purposes. Transporting s to SA appointments. Direct provision of s other than transportation or interpreter s. Transportation that does not involve the member s treatment or recovery. Transportation of family members. Can also be used to provide translation s for Deaf s or s who speak a language other than English.

4 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Individual H0038 HF Group H0038 HQ HF Individual via H0038 HF GT Group via H0038 HQ HF GT to High School diploma 24 months of clean time Certification as a Mentor (PSM) No conviction of crimes against a person Approved PSM provider SRS will review files for licensing, including: assessment, tx plan, progress notes and KCPC, peer support plan, Progress notes, end dates and times for the s 6/18/08, 11:00 am to 11:15 am would Outpatient or intensive modalities or as a standalone ; but must be face to face with the. individually or in a group. If used in a group, no more than 10 participants per PSM. Any /AAPS Individual - $14 for MCD and $10 for AAPS per 15 Group - $7 for MCD and $5 for AAPS per s = 1 unit per 12 Provide and advocate for effective recoverybased s that allow people to thrive in their communities and access naturally occurring community supports. s typically provided by a licensed drug and alcohol counselor, s typically provided by a sponsor, mental health counseling, or medication administration.

5 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Crisis Intervention H0007 Crisis Intervention via H0007 GT to High School diploma 2 years SA work experience in a substance abuse treatment program Sign off by a LAC or LCAC counselor Approved or AAPS provider SRS will review files for licensing, including: assessment, tx plan, progress notes and Can only be used in an setting; but must be face to face with the. Any /AAPS $32.50 for MCD and $16.50 for AAPS per 15 units per per 4 units Crisis = it is not safe for the member to wait for a substance abuse group or individual session to take place. If someone is in need of crisis intervention more than two times a month, a different level of care or mental health evaluation should be considered. Individuals in crisis who require this may be experiencing mental health symptoms during the crisis. Mental health issues should be recognized and addressed in an integrated fashion as it may add to the risk increasing the need for coordination of care. Billing for s not related to a crisis with a substance abuse component.

6 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Telemedicine GT Modifier added to s performed Q3014 facility code to Approved or AAPS provider Licensed or certified for the type of performed Notation in the KCPC and clinical record about the location of the member and why was chosen as the delivery method Can only be provided for treatment modalities not including IOP. The member and provider must be in separate secure locations. There must be a and visual component to the (provider and member should be able to see one another). Any AAPS or member who cannot participate in face to face treatment. The member should not be in the same city as the provider. The rate for the is the same as the non rate. The rate for MCD is Q3014 = $5.00/15. $40 /day maximum. The rate for AAPS is Q3014 = $5.00/15. $40 /day maximum. units per per units dependent upon the care provided. There is a maximum daily allowable charge for reimbursement for Q3014. IT security and infrastructure consistent with standards Can be performed for modalities (such as individual or assessments) only. The same provider cannot bill for the same on the same day if it is delivered via and face to face. Webcams Telephonic only s There MUST be a visual component for delivery. Telemedicine s for residential s such as Intermediate and Reintegration If you have any questions about what can/can not be billed, please contact Sheree Marzka at sheree.marzka@valueoptions.com Case Management (CM): member centered to assist individuals to become more self-sufficient through an array of s which assess, plan, implement, coordinate, monitor and evaluate the options and s to meet an individuals needs using communication and available resources to promote quality, cost effective outcomes. s should address an individual s major lifestyle, attitudinal and behavioral problems that have the potential to create barriers to the goals of treatment. Person Centered Case Management (PCCM): available to eligible populations if delivered by a certified PCCM under the AAPS policy for PCCM. s are provided from a person centered strength based approach. s are based on barrier reduction for engagement, retention and recovery through the development of community support s. The delivery of s is guided by the member s personal wellness plan and incorporates the process of structured engagement. For more information on how to become PCCM certified, please contact Charley Bartlett at charles.bartlett@srs.ks.gov

7 Detailed Coding Grid ( and AAPS ): Updated 1/17/12 Support s: These are supplemental s offered to assist the recovering person in accessing and coordinating community resources that would support his/her abstinence from alcohol and other drugs. Support s provides for the financial reimbursement of s that the Block Grant and funded providers perform outside of the agencies physical location to assist the with the needed resources to facilitate access, engagement and retention in treatment and recovery s such as transportation. Support s are provided outside of the agency s physical location.